Regenerate bone quality during Ilizarov distraction osteogenesis is best assessed by which radiographic criterion during the consolidation phase?

• A Complete cortical bridging on at least 3 of 4 cortices on AP and lateral views ✓
• B Absence of callus in the distraction gap
• C Reconstitution of the medullary canal alone
• D Return of periosteal shadow at the osteotomy site

Explanation

Frame removal after Ilizarov distraction osteogenesis is safe when the regenerate has consolidated adequately. The standard radiographic criterion for frame removal is cortical continuity visible on at least 3 of 4 cortices (on both AP and lateral views) — indicating robust regenerate bone that can withstand physiological loading without fracture. Premature frame removal before 3-cortex bridging risks refracture through the regenerate. The consolidation index is approximately 1 month per cm of lengthening, but radiographic confirmation of bridging is mandatory before frame removal regardless of time.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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