Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.

Objective: It is important to protect the mobile segment in the lumbar region in scoliosis surgery. The aim of this study was to compare the clinical and radiological results of patients who underwent surgery for a diagnosis of adolescent idiopathic scoliosis (AIS) with the lowest instrumented vertebra (LIV) at L3 or L4 level. Methods: The study included 36 patients who underwent surgical treatment in our institution for a diagnosis of Lenke type 5 and 6 AIS with a follow-up period of at least 24 months. The patients were separated into 2 groups according to the LIV level of L3 (n=21) and L4 (n=15). These 2 groups were compared preoperatively (PO), early postoperative (EPO), and at the final follow-up examination (last control (LC)) with respect to radiological parameters in the coronal and sagittal planes, and the Scoliosis Research Society - 22 (SRS-22) questionnaire values. Results: In both groups the mean age (L3: 16 ± 7.3; L4: 17 ± 6.1 years) and follow-up periods (L3: 44 ± 20; L4: 47 ± 18 months) were similar. Radiologically, the L4 group had a greater Cobb angle in the scoliosis main curves measured PO (P=.001). The Cobb angles measured at EPO (P=.767) and at LC (P=.674) were similar in both groups. No significant difference was observed between the 2 groups in respect of the LIV tilt values at PO (P=.469), EPO (P=.297), and LC (P=.065). When the groups were evaluated separately, the LIV tilt values at EPO and LC were similar in the L4 group (EPO: 6.93 ± 3.058; LC: 7.26 ± 2.313; P=.618). In the L3 patients, although there seemed to be a significant increase in LIV tilt values when EPO values were compared with LC values (EPO: 8.47 ± 3.970; LC: 9.57 ± 3.76; P=.030), this was within the error range of Cobb angle measurement. The results of the SRS-22 questionnaire showed significantly better results in the L3 group in the domains of pain, function/activity, mental health, and satisfaction with treatment (P=.011, P=.002, P=.019, P=.046, respectively). Conclusion: There was no radiological superiority between L3 and L4 LIV groups in the thoracolumbar/lumbar curve patients. However, according to the SRS-22 questionnaire, the results of patients with L3 level LIV were better in the areas of pain, function/activity, mental health, and satisfaction with treatment. Cite this article as: Baymurat AC, Tokgoz MA, Abdulaliyev F, Tosun MF, Can MM, Senkoylu A. Which lumbar vertebra should be the lowest level of fusion in adolescent idiopathic scoliosis of Lenke types 5 and 6? Acta Orthop Traumatol Turc., 2024;58(2):116-123.

Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.

Background and Objectives: Acetabular fracture surgery is associated with substantial perioperative blood loss and prolonged operative time. Routine preoperative pelvic computed tomography (CT) carries information about body composition that is not currently exploited for risk stratification. We tested whether (i) CT-defined pelvic sarcopenia is associated with lower preoperative haemoglobin and (ii) preoperative subcutaneous fat cross-sectional area (CSA) is independently associated with operative time, after adjustment for surgical approach, age, fracture complexity and sarcopenia status. Materials and Methods: In this single-centre retrospective cohort study, 48 adults (37 men, 11 women; mean age 40.2 ± 16.5 years) who underwent open reduction and internal fixation (ORIF) for unilateral acetabular fractures between 2016 and 2024 were included. Pelvic muscle and subcutaneous fat CSAs were measured on the contralateral side of preoperative CT images using ImageJ. Sarcopenia was defined as an internal, cohort-relative classification based on the sex-specific bottom tertile of psoas CSA. Normality was assessed by Shapiro–Wilk testing; Pearson or Spearman correlation was used accordingly, and the 36 pairwise correlations were controlled with the Benjamini–Hochberg false-discovery-rate procedure. The multivariable model used ordinary least squares regression with heteroscedasticity-consistent (HC3) standard errors and a median quantile-regression robustness check. Results: Sarcopenic patients (n = 17) had significantly lower preoperative haemoglobin (12.63 ± 1.24 vs. 14.00 ± 1.53 g/dL; p = 0.002; Cohen’s d = 0.96). The absolute perioperative haemoglobin drop was numerically smaller in the sarcopenic group (ΔHb 1.64 ± 0.91 vs. 2.46 ± 1.87 g/dL) but did not reach statistical significance (p = 0.079); estimated blood loss (p = 0.258) and transfusion requirement (p = 0.567) did not differ between groups. Pelvic muscle CSAs correlated positively with preoperative haemoglobin (all q < 0.05 after Benjamini–Hochberg correction). In the multivariable model (F[6, 41] = 3.71, p = 0.005; adjusted R² = 0.26; all variance inflation factors 1.06–1.26), subcutaneous fat CSA (B = +0.25 min/cm², p = 0.004) and the modified Stoppa approach (vs. Kocher–Langenbeck; +65 min, p = 0.001) were independently associated with operative time. Conclusions: In this exploratory retrospective cohort, routine preoperative pelvic CT contained two body-composition signals that may warrant prospective evaluation: pelvic sarcopenia, which was associated with lower baseline haemoglobin, and subcutaneous adiposity, which was associated with longer operative time in the primary regression model. Both signals require confirmation—the sarcopenia–bleeding relationship was not statistically significant, and the subcutaneous fat association was attenuated under robust inference. These findings are hypothesis-generating; prospective multicentre validation with height-normalised sarcopenia thresholds and body mass index is required before clinical implementation.

Purpose: The shape and size of Gerdy’s tubercle (GT) vary among individuals. This study aimed to investigate not only the anatomical differences in GT—particularly its size and shape—on dry tibiae and cadavers, but also its precise localization and distances to the tibial plateau. The findings may assist surgeons in preoperative planning for total knee arthroplasty (TKA). In addition, the morphometric structure of the tibial plateau was examined to provide a detailed description of the tibial plateau. Methods: A total of 100 dry tibiae and 18 formalin-fixed cadaveric knee-leg specimens were examined using a digital caliper. The width, height, and distances between the GT and surrounding structures were recorded. Morphometric parameters of the tibial plateau were also measured. Statistical analyses were performed using SPSS software. Results: GT dimensions and their distances to adjacent structures were proportional to tibial length. The most common GT morphology was triangular, with a smooth surface and the tip at the center. GT height, width, and distances to surrounding structures were greater in cadaveric specimens compared to dry bones. All GT measurements were positively correlated, and tibial plateau parameters demonstrated positive correlations with GT dimensions. Conclusion: This study demonstrates that dimensional variations can influence tibial plateau morphometry and that asymmetry exists between the medial and lateral condyles. These findings emphasize the importance of patient-specific implants in total knee arthroplasty (TKA). Moreover, the detailed morphometric description of Gerdy’s tubercle (GT) presented here may serve as a valuable reference for clinical evaluation, surgical planning, and intraoperative decision-making in TKA.