Fracture healing: types of nonunion: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Fracture healing: types of nonunion

Sample item

Radiographs of an ununited tibial fracture show hypertrophic callus with a persistent fracture line and flared bone ends, often called an elephant foot. What is the main problem and treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Hypertrophic nonunion with good biology but inadequate stability, so rigid fixation is needed

Hypertrophic nonunion has abundant callus, showing adequate biology but excessive motion at the fracture. Rigid stabilisation, such as an exchange nail or compression plating, usually leads to union. Atrophic nonunion needs fixation together with bone grafting.

Option by option

  • A. Atrophic nonunion with poor biology needing only a cast

    Atrophic nonunion shows little callus and tapered ends.

  • B. Synovial pseudarthrosis needing no treatment

    Pseudarthrosis requires treatment to achieve union.

  • C. Infected nonunion needing only antibiotics

    Infection may coexist but is not proven by this picture.

  • D. Hypertrophic nonunion with good biology but inadequate stability, so rigid fixation is needed (correct)

    Correct. The callus indicates good biology and the missing element is stability.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is D, Hypertrophic nonunion with good biology but inadequate stability, so rigid fixation is needed. Hypertrophic nonunion has abundant callus, showing adequate biology but excessive motion at the fracture.

Why is "Atrophic nonunion with poor biology needing only a cast" not the answer?

Atrophic nonunion shows little callus and tapered ends.

Why is "Synovial pseudarthrosis needing no treatment" not the answer?

Pseudarthrosis requires treatment to achieve union.

Why is "Infected nonunion needing only antibiotics" not the answer?

Infection may coexist but is not proven by this picture.

What concept does this question test?

It tests Fracture healing: types of nonunion in Orthopaedics. Rigid stabilisation, such as an exchange nail or compression plating, usually leads to union. Atrophic nonunion needs fixation together with bone grafting.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Fracture healing: types of nonunion?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.