title: Is there a regional difference in morphology interpretation of A3 and A4 fractures among different cultures?
abstract: OBJECT The aim of this study was to determine if the ability of a surgeon to correctly classify A3 (burst fractures with a single endplate involved) and A4 (burst fractures with both endplates involved) fractures is affected by either the region or the experience of the surgeon. METHODS A survey was sent to 100 AOSpine members from all 6 AO regions of the world (North America, South America, Europe, Africa, Asia, and the Middle East) who had no prior knowledge of the new AOSpine Thoracolumbar Spine Injury Classification System. Respondents were asked to classify 25 cases, including 6 thoracolumbar burst fractures (A3 or A4). This study focuses on the effect of region and experience on surgeons' ability to properly classify these 2 controversial fracture variants. RESULTS All 100 surveyed surgeons completed the survey, and no significant regional (p > 0.50) or experiential (p > 0.21) variability in the ability to correctly classify burst fractures was identified; however, surgeons from all regions and with all levels of experience were more likely to correctly classify A3 fractures than A4 fractures (p < 0.01). Further analysis demonstrated that no region predisposed surgeons to increasing their assessment of severity of burst fractures. CONCLUSIONS A3 and A4 fractures are the most difficult 2 fractures to correctly classify, but this is not affected by the region or experience of the surgeon; therefore, regional variations in the treatment of thoracolumbar burst fractures (A3 and A4) is not due to differing radiographic interpretation of the fractures.
authors.affiliation: The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Schroeder
authors.affiliation: The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Kepler
authors.affiliation: The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: John D
authors.initials: JD
authors.lastname: Koerner
authors.affiliation: The Swedish Neuroscience Institute.
authors.forename: Jens R
authors.initials: JR
authors.lastname: Chapman
authors.affiliation: University of Washington, Seattle, Washington.
authors.forename: Carlo
authors.initials: C
authors.lastname: Bellabarba
authors.affiliation: University Medical Center, Utrecht, The Netherlands.
authors.forename: F Cumhur
authors.initials: FC
authors.lastname: Oner
authors.affiliation: Medical University Innsbruck, Department of Orthopaedic Surgery, Innsbruck, Austria.
authors.forename: Max
authors.initials: M
authors.lastname: Reinhold
authors.affiliation: University of British Columbia, Vancouver, British Columbia.
authors.forename: Marcel F
authors.initials: MF
authors.lastname: Dvorak
authors.affiliation: University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Bizhan
authors.initials: B
authors.lastname: Aarabi
authors.affiliation: Catholic University, Curitiba, Brazil.
authors.forename: Luiz
authors.initials: L
authors.lastname: Vialle
authors.affiliation: University of Toronto, Ontario, Canada.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fehlings
authors.affiliation: Ganga Hospital, Coimbatore, India.
authors.forename: Shanmuganathan
authors.initials: S
authors.lastname: Rajasekaran
authors.affiliation: Centerfor Spinal Surgery and Neurotraumatology, BG Unfallklinik Frankfurt; and.
authors.forename: Frank
authors.initials: F
authors.lastname: Kandziora
authors.affiliation: Schön Klinik Nürnberg Fürth, Center for Spinal Surgery, Fürth, Germany.
authors.forename: Klaus J
authors.initials: KJ
authors.lastname: Schnake
authors.affiliation: The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
keywords: A3 fracture; A4 fracture; AOSpine Thoracolumbar Spine Injury Classification System; PLC = posterior ligamentous complex; SIS = Spine Injury Score; TLICS = Thoracolumbar Injury Classification and Severity Score; regional radiographic interpretation; regional treatment variation; thoracolumbar burst fractures; trauma