Martin Riegger

Purpose: Methods: Results: Conclusion:

Background: In hallux valgus correction surgery, different fixation methods exist for Akin’s osteotomy, but no fixation is also a possibility. We hypothesized that Akin’s osteotomy, both fixed and non-fixed, would provide equally sufficient correction of the phalanx without differences in the measurements of the specific postoperative DASA and IPOA angles and no significant differences between the two groups in the rate of complications. Methods: A retrospective single-center comparative case–control study was conducted. Five radiological measurements were analyzed until completion of fusion. The incidence of complications occurring during and after surgery was assessed and compared across the study groups. Results: A total of 200 Akin osteotomies were evaluated; 100 were included in the group without fixation and 100 in the group with fixation. Radiologically, the results show that there is no difference in the corrective difference values in the main parameters between the groups. Regarding the analysis of complications, in the group without fixation, all cases achieved fusion. In the group with fixation, one case showed non-symptomatic non-union. Out of 200 operations, four (2%) patients required reoperation. A re-Akin osteotomy was needed for a hypocorrection in the group without fixation. One case in the fixed group went into asymptomatic non-union that did not require re-intervention. Conclusions: The absence of internal fixation does not seem to compromise the healing of the osteotomy, and the maintenance of correction grades and complication rates in the group without fixation seems to be similar to the group with fixation. The results are promising; however, we believe that further studies are needed to confirm the data.

The National Advisory Committee for Aeronautics (NACA) score is widely used to assess polytrauma patients. NACA scores of 4 and 5 indicate severe and poten

Purpose: The aim of this study was to quantify differences in the shear wave speed (SWS) between a conservatively treated Achilles tendon (AT) after rupture and the unaffected contralateral tendon.Methods: Twenty‐nine participants who received conservative treatment following Achilles tendon rupture (ATR) were enrolled. Measurements were taken during a single follow‐up visit, which occurred between 1 and 7 years after the rupture. Tendon load was assessed using a shear wave tensiometer comprising a set of four accelerometers attached to the tendon. Stiffness, thickness, and cross‐sectional area (CSA) were also assessed using MyotonPRO and ultrasound imaging.Results: No significant differences in SWS were found between the affected AT and the unaffected side when analyzing the entire group (p > 0.05). However, significant differences between sides were observed at 3.5 Nm and 7 Nm (p = 0.001 and p = 0.020) for participants that experienced a lesion of the mid tendon. Higher plantar flexor strength was found for the unaffected side (320 ± 99.5 Nm) compared to the affected side (261 ± 80 Nm; p = 0.001). Thickness and CSA in the proximal and distal part of the tendon were significantly higher in the affected tendon compared to the unaffected side (p < 0.001).Conclusion: There is no difference in SWS values between the affected and the unaffected AT in the longer term after the rupture. However, differences in SWS were detected at specific contraction levels in participants with a mid‐tendon lesion. Moreover, tendon thickness and the cross‐sectional area, as well as plantar flexor strength, remain different between the affected and the unaffected AT.

Purpose: The association between fluoroquinolone intake and Achilles tendinopathy (AT) or Achilles tendon rupture (ATR) is widely documented. However, it is not clear whether different molecules have the same effect on these complications. The purpose of this study was to document Achilles tendon complications for the most prescribed fluoroquinolones molecules. Methods: A literature search was performed on Pubmed, Cochrane, Embase, and Web of Science databases up to April 2023. Inclusion criteria: studies of any level of evidence, written in English, documenting the prevalence of AT/ATR after fluoroquinolone consumption and stratifying the results for each type of molecule. The Downs and Black’s ‘Checklist for Measuring Quality’ was used to evaluate the risk of bias. Results: Twelve studies investigating 439,299 patients were included (59.7% women, 40.3% men, mean age: 53.0 ± 15.6 years). The expected risk of AT/ATR was 0.17% (95% CI: 0.15–0.19, standard error (s.e.): 0.24) for levofloxacin, 0.17% (95% CI: 0.16–0.19, s.e.: 0.20) for ciprofloxacin, 1.40% (95% CI: 0.88–2.03, s.e.: 2.51) for ofloxacin, and 0.31% (95% CI: 0.23–0.40, s.e.: 0.77) for the other molecules. The comparison between groups documented a significantly higher AT/ATR rate in the ofloxacin group (P < 0.0001 for each comparison). Levofloxacin and ciprofloxacin showed the same risk (P = n.s.). The included studies showed an overall good quality. Conclusion: Ofloxacin demonstrated a significantly higher rate of AT/ATR complications in the adult population, while levofloxacin and ciprofloxacin showed a safer profile compared to all the other molecules. More data are needed to identify other patient and treatment-related factors influencing the risk of musculoskeletal complications.

Background: The benefit of intradiscal glucocorticoid injection (IGI) for discogenic low back pain (LBP) remains controversial.Objectives: The objective of this study was to systematically assess and meta-analyze the efficacy of IGI compared with these control groups.Study Design: Systematic review and meta-analysis. Methods: A comprehensive literature search was performed screening PubMed and Embase through May 2022. Only randomized controlled trials (RCTs) comparing IGI to control groups in adult patients with discogenic lumbar back pain were included. A random effects model was used to pool mean differences of pain intensity (visual analaog scale [VAS] 0-100), and physical function assessed with the Oswestry Disability Index (ODI). Subgroup analyses were stratified by Modic magnetic resonance imaging findings. Results: Seven studies met inclusion criteria with a total of 626 patients. The short-term (< 3 months) follow-up showed a significant pooled mean difference in both pain intensity (-20.1; 95% CI,-25.5 to-14.7) and physical function (-9.9; 95% CI,-16.1 to-3.6). In the intermediate-term follow-up (3 to < 6 months), only physical function remained significantly better in the glucocorticoid group (-13.1; 95% CI,-22.3 to-3.9). There was no clinically meaningful or significant difference in pain scores and physical function at the long-term (>= 6 months) follow-up. A subgroup analysis did not demonstrate an effect of Modic (type I) changes on the efficacy of IGI.Limitations: A limited number of studies was available and consequently publication bias could not be evaluated using a funnel plot. Statistical heterogeneity was detected among the included studies.Conclusion: We conclude that IGI reduces discogenic LBP intensity and improves physical function effectively at short-term follow-up, and continues to improve physical function at intermediate-term. However, 6 months posttreatment, outcomes are similar in comparison to the control groups. The type of Modic change does not appear to be related with the response to IGI.

Background: The myocardial uptake of bone-seeking tracers suspicious for transthyretin cardiac amyloidosis (ATTR-CA) can be incidentally detected in patients undergoing bone scintigraphy for noncardiac reasons. We conducted a systematic review and meta-analysis to assess the prevalence of these scintigraphic findings. Methods: A comprehensive literature search was performed using two bibliographic databases (PubMed/MEDLINE and Cochrane Library), searching for articles related to the review question. Eligible articles were selected, and relevant data were extracted by two authors. The pooled prevalence of incidental findings suspicious for ATTR-CA among patients undergoing bone scintigraphy was calculated on a per-patient-based analysis using a random-effects model. The pooled measure was provided with 95% confidence interval (95% CI) values. Results: Among 219 records, 11 articles were selected for the systematic review and 10 for the meta-analysis. The pooled prevalence of incidental findings suspicious for ATTR-CA was 1.1% (95% CI: 0.7–1.4%) with heterogeneity due to the characteristics of the included studies, patients, and index tests. These findings are more prevalent in older men. Conclusions: The prevalence of incidental findings of ATTR-CA among patients undergoing bone scintigraphy is low but not negligible. Nuclear medicine physicians should suggest, in the scintigraphic report, further clinical investigations when these findings are detected. Prospective studies are warranted.

Purpose: The biomechanical characteristics of different techniques to perform the modified Lapidus procedure are controversial, discussing the issue of stability, rigidity, and compression forces from a biomechanical point of view. The aim of this systematic review was to investigate the available options to identify whether there is a procedure providing superior biomechanical results. Methods: A comprehensive literature search was performed by screening PubMed, Embase, and Cochrane databases until September 2021. There was a wide heterogeneity of the available data in the different studies. Load to failure, stiffness, and compression forces were summarized and evaluated. Results: Seventeen biomechanical studies were retrieved – ten cadaveric and seven polyurethane foam (artificial bone) studies. Fixation methods ranged from the classic crossed screw approach (n = 5) to plates (dorsomedial and plantar) with or without compression screws (n = 11). Newer implants such as intramedullary stabilization screws (n = 1) and memory alloy staples (n = 2) were investigated. Conclusion: The two crossed screws construct is still a biomechanical option; however, according to this systematic review, there is strong evidence that a plate–screw construct provides superior stability especially in combination with a compression screw. There is also evidence about plate position and low evidence about compression screw position. Plantar plates seem to be advantageous from a biomechanical point of view, whereas compression screws could be better when positioned outside the plate. Overall, this review suggests the biomechanical advantages of using a combination of locking plates with a compression screw.

This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed at comparing resurfacing hip arthroplasty (RHA) and total hip arthroplasty (THA) in terms of rate of complications, revisions, functional outcomes, blood loss, operative time and metal ions levels. The search was conducted on three databases (PubMed, Cochrane and Web of Science) updated until 13 October 2022. The inclusion criteria were RCTs) written in the English language, with no time limitation, comparing RHA and THA. Among the retrieved 4748 articles, 18 RCTs were eligible for a total of 776 patients (mean age 53.1 ± 5.0). A meta-analysis was performed. RHA reported significantly lower blood loss compared to THA (p < 0.001) but with longer operative time (p < 0.001). No statistically significant difference was found between RHA and THA in terms of complications (12.08% and 16.24%, respectively) and revisions (6.32% and 6.14%, respectively). Both RHA and THA provide excellent clinical results in a population of young and active patients. Functional outcomes were not significantly different between the groups. Moreover, no significant difference in metal ion levels was found. These findings provide evidence concerning the safety and clinical effectiveness of RHA. Because of its bone-preserving properties, the lack of drawbacks and good outcomes, RHA appears to be a valid alternative to THA in young and active patients.