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Review Question - QID 4025

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QID 4025 (Type "4025" in App Search)
A 27-year-old male presented to the trauma bay following a motor vehicle crash and was diagnosed with a comminuted open tibia fracture. He was subsequently treated with an irrigation and debridement, and un-reamed intramedullary nail. At 4 months follow-up, despite some signs of healing, the fracture is not fully united. Which of the following is true?