Patients with A3 and A4 fractures had similar odds to reach MCID in ODI score at 1 year. Even when exclusively considering the nonoperative cohort of patients who sustained A4 fractures with perceived increased biomechanical stability, there was no difference in functional improvement compared to patients with A3 fractures. Further large prospective multicenter studies are required to specifically assess radiographic outcomes and compare surgical approaches in the management of A3 and A4 fractures.
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Tee et al. (2025) studied this question.
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