Objective: It was aimed at evaluating the effect of the size of the pedicle screw placed on the fractured vertebra on the long-term radiological and clinical results of short-segment posterior instrumentation applied in the surgical treatment of thoracolumbar vertebral fractures. Methods: This retrospective study included 36 patients who underwent short-segment posterior instrumentation surgery for a single-level thoracolumbar (T11-L2) fracture between January 2015 and March 2021. The patients included in the study were divided into 2 groups according to the size of the pedicle screw placed in the fractured vertebra (group A: intermediate screw 4.5 mm, ≤35 mm+less than 50% of the vertebral corpus length, m/f: 13/4, n: 17, age: 36.5; group B: intermediate screw 5.5 mm, ≥40 mm+more than 70% of the vertebral corpus length, m/f: 11/8, n: 19, age: 42.6). All patients were periodically evaluated clinically and radiologically. Vertebral compression angle (VCA), anterior and posterior vertebral body height (ABH-PBH), intraoperative parameters (instrumentation time and intraoperative fluoroscopy number), and complications were compared between the 2 groups. Results: Both groups were comparable with respect to age, sex, level of injury, AO classification, mechanism of injury, and American Spinal Cord Injury Association impairment scale. Restoration of VCA and vertebral corpus heights was achieved sufficiently in both groups after operation (P < .0001). There was no significant difference between the 2 groups in terms of early postoperative VCA, VCA measured at final follow-up, or loss of correction in VCA. At the last follow-up, PBH was statistically significantly better preserved in group B (P=.0424). There was no difference between the 2 groups in terms of operation time and the number of intraoperative fluoroscopies. Implant failure was observed in 1 patient in group A. Conclusion: This study has revealed that using a long, thick pedicle screw placed in the fractured vertebra can better preserve the PBH at the final follow-up. No correlation was found between the size of the intermediate screw and the preservation of the correction in the postoperative vertebral heights and VCA during the follow-up. Level of Evidence: Level III, Therapeutic Study. Cite this article as: Öztürk AM, Süer O, Aydemir S, Kılıçlı B, Akçalı Ö. The effect of the size of pedicle screw on the long-term radiological and clinical results of short-segment posterior instrumentation in the management of thoracolumbar vertebral fractures. Acta Orthop Traumatol Turc., 2024;58(1):20-26.

Avascular necrosis (AVN) of the femoral head lacks a standardized classification system, with multiple systems used in clinical practice by orthopedic surgeons, radiologists, and clinicians treating this condition. Differences in the reliability and diagnostic criteria across existing classification systems can give rise to conflicts in the treatment decisions made. Therefore, identifying the most reliable and uniform classification system is crucial for optimal patient care and treatment planning. This research aimed to identify the most reliable and uniform classification system across all therapeutic results. It also considered precision and dependability as diagnostic standards among these systems. This retrospective observational study was conducted between January 2021 and January 2023, involving 20 patients who had avascular necrosis of the femoral head confirmed by magnetic resonance imaging. The reliability of diagnosis was evaluated using five main classifications (Ficat and Arlet, Steinberg, Mitchell, ARCO, Marcus Enneking) at two different time points: initially and after one month, assessed by two orthopedic surgeons and one radiologist. Key measures included the intraclass correlation coefficient (ICC) for interobserver agreement/intraobserver consistency, Spearman’s rho for MRI progression correlation, and staging outcome analysis of variance. The findings showed that classification systems have different diagnostic precision. Furthermore, the Marcus Enneking scoring system recorded the best diagnostic performance (AUC = 0.65, p < 0.01) and the strongest association with MRI progression (rho = 0.65) whereas Mitchell’s staging caused significant stage discrepancies between them. Marcus Enneking also had good intraobserver reliability based on kappa values, which was not the case for other techniques. Our study demonstrates varying levels of reliability and diagnostic precision among different classification systems for femoral head avascular necrosis. The Marcus Enneking system seems to perform better as compared to the other systems by exhibiting a strong diagnostic accuracy and correlation with the MRI progression, this indicates that it might be more appropriate for clinical practice. Additional studies are necessary to determine how these differences in classification systems directly influence treatment outcomes in clinical practice. Level III (Retrospective observational study).

The correlation between clinical outcomes and preoperative/postoperative measures of the lateral center-edge angle (LCEA) will help establish the cutoff values for this measurement and determine whether to obtain it from the lateral acetabular rim (LCEA_R) or the lateral end of the sourcil (LCEA_S). The hypothesis was that the LCEA_S would be more sensitive than the LCEA_R. An upper cutoff value of LCEA could predict better functional outcomes in FAI patients. 106 patients (103 unilateral, 3 bilateral) who underwent hip arthroscopy surgery due to FAI and had a minimum 2-year follow-up were included. Patient-reported outcomes included the mHHS and visual analogue scale for pain (Pain VAS). Radiological parameters (alpha angle, LCEA_S, LCEA_R) were evaluated at the pelvis, 45° Dunn X-rays. A receiver operating characteristic analysis was used to evaluate the correlation between significant variables and achievement of patient-acceptable symptomatic state (PASS) and calculate area under the curve (AUC) and critical values for LCEA. The mean age of the patients was 34 ±10 years with a mean follow-up of 5 years. There were 75 male and 31 female patients. The mHHS improved from 57 ± 11 before surgery to 93 ± 8 after surgery (P < .001). The Pain VAS decreased from 6 before surgery to 1 after surgery (P < .001). A higher frequency of reaching the PASS threshold for mHHS was associated with lower preoperative and postoperative _dunn LCEA_S and postoperative _dunn LCEA_R. Preoperative _dunn LCEA_S ≤ 24.8° had an AUC of 0.67, predicting PASS (+) with 0.38 sensitivity and 0.93 specificity. Combining LCEA_S with other parameters further improved predictability. LCEA_S seems more predictive of clinical significance than LCEA_R. However, predictivity exceeds the acceptable limit when they are measured together. The upper values for LCEA_S and LCEA_R seem to be 24° and 35°, respectively.

The alpha angle is a radiological measurement that has been proposed for the detection of cam morphology in patients suspected of femoroacetabular impingement syndrome (FAIS). After analysing published articles on FAIS, it is apparent that different types of circles are used in the measurement of alpha angles. To determine the interobserver and intraobserver reliability of alpha angle values measured using different types of circles on a 45° Dunn lateral radiograph in patients with symptomatic FAIS. The 45° Dunn lateral radiographs of the operated hips of patients who underwent hip preservation surgery in Dokuz Eylül University Hospital between 2014 and 2017 were evaluated retrospectively. Alpha angles were measured manually with transparent goniometers using three different circle types: thin full circle, thin-dashed circle, and thick full circle, and eye estimation without circle insertion. Measurements were made separately by an orthopaedist and a radiologist. A second measurement was made by the radiologist 1 month later for intraobserver reliability. Interobserver reliability for the thin full circle, thin-dashed circle, thick circle, and eye estimation (ICC = 0.645, 0.525, 0.494, and 0.588, respectively). Intraobserver reliability for the thin, thin-dashed, thick line, and eye estimation (ICC= 0.626, 0.681, 0.681, and 0.462 respectively). Interobserver difference of mean values of alpha angles for thin full, thin-dashed, thick full, and eye estimation were 2.7°, 0.9°, 1.1°, and 2.3°, respectively. Intraobserver differences between measurements were 1.5°, 0.9°, 0°, and 1.6°, respectively. Our study demonstrated that interobserver reliability is highest when measurements are made using a thin full circle.