Fracture healing: 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

Sample item

A tibial shaft fracture treated in a cast shows no union at nine months. The radiograph shows flaring, sclerotic bone ends with abundant callus (elephant foot) and a persistent gap, and the fracture still moves. What is the key principle of treatment?

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

The answer and the reasoning

A. Provide rigid stability with internal fixation

This is hypertrophic nonunion, in which healing biology and blood supply are good but mechanical stability is inadequate. Rigid fixation alone usually allows the fracture to unite, while atrophic nonunion needs biological stimulation such as bone grafting as well.

Option by option

  • A. Provide rigid stability with internal fixation (correct)

    The abundant callus shows the biology is adequate, so stability is what is missing.

  • B. Prolonged immobilisation in a plaster cast

    More plaster has already failed to give enough stability over many months.

  • C. Electrical stimulation alone

    Stimulation does not correct the instability that causes this type of nonunion.

  • D. Extensive bone grafting without fixation

    Grafting without stability would not control the motion that is preventing union.

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.

More Orthopaedics questions

Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is A, Provide rigid stability with internal fixation. This is hypertrophic nonunion, in which healing biology and blood supply are good but mechanical stability is inadequate.

Why is "Prolonged immobilisation in a plaster cast" not the answer?

More plaster has already failed to give enough stability over many months.

Why is "Electrical stimulation alone" not the answer?

Stimulation does not correct the instability that causes this type of nonunion.

Why is "Extensive bone grafting without fixation" not the answer?

Grafting without stability would not control the motion that is preventing union.

What concept does this question test?

It tests Fracture healing in Orthopaedics. Rigid fixation alone usually allows the fracture to unite, while atrophic nonunion needs biological stimulation such as bone grafting as well.

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?

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.