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  • Author: Enrique Adrian Testa x
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Martin Riegger Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland

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Nermine Habib Department of Orthopedic Surgery, Hopital fribourgeois (HFR) – Freiburger Spital (HFR), Fribourg, Switzerland

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Enrique Adrian Testa Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Bellinzona, Switzerland

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Jochen Müller Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland

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Marco Guidi Department of Plastic Surgery and Hand Surgery, Kantonsspital, Aarau, Switzerland

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Christian Candrian Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland

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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.

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Alessandro Sangiorgio Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland

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Martina Sirone Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland

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Federico Maria Adravanti Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

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Enrique Adrian Testa Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland

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Martin Riegger Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland

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Giuseppe Filardo Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

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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.

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