Single Photon Emission Computed Tomography-Computed Tomography (SPECT/CT) gains an important part of diagnostics in patients with osteochondral lesions (OCL). SPECT/CT is a hybrid imaging modality, which combines a 3D scintigraphy (SPECT) and computerized tomography (CT) into one single procedure and combines metabolic data, structural and mechanical information. The purpose of the study was to develop and evaluate a standardized method to anatomically localize and quantitatively analyze the bone SPECT tracer activity of the ankle joint using SPECT/CT. OCL on the talus were diagnosed in 16 patients by 99mTc-HDP-SPECT/CT and MRI by specialized orthopedic surgeons and radiologists and retrospectively included. The articular superior surface of the talus was subdivided in six anatomical regions (T1–T6). Using customized software, absolute bone SPECT values for each anatomical area were analyzed. Relative bone tracer uptake was calculated in relation to specific reference regions representing bone SPECT tracer background activity. All measurements were performed twice by two independent observers, blinded to clinical information. Intraclass correlation coefficients (ICC) were calculated for inter- and intra-observer reliability. The intraclass correlation coefficients (ICC) showed an excellent inter- and intra-observer reliability. The intraclass correlation coefficients (ICC) of all six regions are between 1.00 and 0.84 which is defined as very good. Results from region T1 to T6 impair slightly due to measurement regime. All ICCs of observer 1 were nearly the same as the results of observer 2 in all regions. The presented standardized SPECT/CT algorithm is clinically feasible and showed high inter- and intra-observer reliability. It might help to better understand the complex pathology of OCL on the talar dome. The major potential benefit of SPECT/CT is the assessment of the subchondral bone plate and the subchondral bone.

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.

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.

Purpose: Several authors have described methods to predict the sural nerve pathway with non‐proportional numerical distances, but none have proposed a person‐proportional, reproducible method with anatomical references. The aim of this research is to describe ultrasonographically the distance and crossing zone between a surface reference line and the position of the sural nerve.Methods: Descriptive cross‐sectional study, performed between January and April 2022 in patients requiring foot surgery who met inclusion criteria. The sural nerve course in the posterior leg was located and marked using ultrasound. Landmarks were drawn with a straight line from the medial femoral condyle to the tip of the fibula. Four equal zones were established in the leg by subdividing the distal half of the line. This way, areas based on simple anatomical proportions for each patient were studied. The distance between the marking and the ultrasound nerve position was measured in these 4 zones, creating intersection points and safety areas. Location and distances from the sural nerve to the proposed landmarks were assessed.Results: One‐hundred and four lower limbs, 52 left and 52 right, assessed in 52 patients were included. The shortest median distance of the nerve passage was 2.9 mm from Point 2. The sural nerve intersection was 60/104 (57.7%) in Zone B, 21/104 (20.1%) in Zone C and 19/104 (18.3%) in Zone A. Safety zones were established. Average 80.5% of coincidence in sural nerve localization was found in the distal half of the leg, in relation to the surface reference line when comparing both legs of each patient.Conclusions: This study proposes a simple, reproducible, non‐invasive and, for the first time, person‐proportional method, that describes the distance and location of the main areas of intersection of the sural nerve with points and zones (risk and safe zones) determined by a line guided by superficial anatomical landmarks. Its application when surgeons plan and perform posterior leg approaches will help to avoid iatrogenic nerve injuries.Level of evidence: IV.

Original version of this article was published with incorrect version of figure 1 and error in author name. These errors now corrected. 1) Revised version of Fig. 1 updated. 2) Error in co-author name corrected as Daniel Cuéllar-Bernal (not as Daniel Cuéllar Berna). The original article has been corrected.