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Review Question - QID 211144

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QID 211144 (Type "211144" in App Search)
A 32-year-old previously healthy male sustained a closed right tibial shaft fracture 15 months prior that was treated with an unreamed intramedullary nail. The patient presents with persistent pain in his right leg with radiographs revealing an "elephant's foot" appearance of the bone at the fracture site with gapping on all four cortices on the AP and lateral radiographs. His medical history is significant for type 1 diabetes for which he uses an insulin pump and denies any related issues. Based on this information, what is the most likely underlying cause of the patient's condition?
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