During a planned 7 cm tibial lengthening with an Ilizarov frame, distraction stops progressing after 4 weeks despite continued turning of the struts. Radiographs show no new regenerate and dense sclerotic ends at the corticotomy site. The most appropriate next step is:

• A Continue distraction at double the previous rate
• B Remove the frame and apply a cast
• C Start bisphosphonate therapy and continue distraction
• D Perform a repeat corticotomy at the same site and resume distraction ✓

Explanation

Premature consolidation is diagnosed when regenerate formation ceases and the osteotomised surfaces fuse, confirmed radiographically by sclerosis without a visible gap. Treatment is repeat corticotomy through the consolidated site followed by resumption of distraction. Doubling the rate will not separate fused bone and risks hardware failure or fracture. Frame removal abandons the goal limb length, and drug therapy cannot dissolve an established bony bridge.

Reference: Rockwood and Green's Fractures in Adults, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.