Cortical Bone Thickness, Base Osteophyte Occurrence and Radiological Signs of Osteoarthritis in the Fingers of Male Elite Sport Climbers: A Cross-Sectional 10-Year Follow-Up Study

Background: Sport climbing places high mechanical loads on fingers. In 2012, our research group demonstrated adaptations of climbers’ cortical bones with the presence of osteophytes compared to non-climbing controls. Objectives: 1) To investigate 10-year changes in cortical bone thickness, base osteophyte occurrence and radiological signs of osteoarthritis in the fingers of elite male sport climbers with more than 25 years of climbing history and 2) to compare cortical bone thickness, base osteophyte occurrence and radiological signs of osteoarthritis between male sport climbers and age-matched controls at the 10-year follow-up. Methods: All 31 elite sport climbers who participated in both the baseline and 10-year follow-up assessments (follow-up rate 100%) were examined by means of X-rays. Cortical bone thickness, presence of osteophytes and signs of osteoarthritis according to Kellgren-Lawrence were obtained and compared to the baseline values 10 years earlier and to age-matched controls at the follow-up (n = 15). Results: Significantly increased cortical bone thickness over the past 10 years was observed in climbers (mean absolute difference with 95% CI:0.98 mm (0.77 mm, 1.19 mm); p <0.001). Moreover, compared to age-matched controls, climbers had significantly thicker cortical bone at the 10-year follow-up (mean absolute difference with 95% CI:0.86 mm (0.61 mm, 1.12 mm); p <0.001). In climbers, osteophytes and clear signs of osteoarthritis were mainly seen in DIP joints. Signs of osteoarthritis according to Kellgren-Lawrence were more prevalent than 10 years before in most joints. In lateral radiographs, base osteophytes were not significantly more prevalent than 10 years before in most of the joints. The percentage of climbers who had osteophytes in any DIP (PIP) joint increased from 93.5% (67.7%) at baseline to 100% (74.2%) at the 10-year follow-up. The percentage of climbers who had clear signs of osteoarthritis according to Kellgren-Lawrence in any DIP (PIP) joint increased from 12.9% (9.7%) at baseline to 74.2% (64.5%) at 10-year follow-up. Only a few such degenerative changes were found in age-matched controls. Conclusion: An accumulation of repetitive climbing-related stress to the fingers of elite sport climbers over the career may induce lifelong mechano-adaptation of the cortical bone thickness of all phalanges. At the 10-year follow-up, a further significant increase in radiographic signs of osteoarthritic changes was observed

Cortical Bone Thickness, Base Osteophyte Occurrence and Radiological Signs of Osteoarthritis in the Fingers of Male Elite Sport Climbers: A Cross-Sectional 10-Year Follow-Up Study

Background: Sport climbing places high mechanical loads on fingers. In 2012, our research group demonstrated adaptations of climbers' cortical bones with the presence of osteophytes compared to non-climbing controls. Objectives: 1) To investigate 10-year changes in cortical bone thickness, base osteophyte occurrence and radiological signs of osteoarthritis in the fingers of elite male sport climbers with more than 25 years of climbing history and 2) to compare cortical bone thickness, base osteophyte occurrence and radiological signs of osteoarthritis between male sport climbers and age-matched controls at the 10-year follow-up. Methods: All 31 elite sport climbers who participated in both the baseline and 10-year follow-up assessments (follow-up rate 100%) were examined by means of X-rays. Cortical bone thickness, presence of osteophytes and signs of osteoarthritis according to Kellgren-Lawrence were obtained and compared to the baseline values 10 years earlier and to age-matched controls at the follow-up (n = 15). Results: Significantly increased cortical bone thickness over the past 10 years was observed in climbers (mean absolute difference with 95% CI:0.98 mm (0.77 mm, 1.19 mm); p <0.001). Moreover, compared to age-matched controls, climbers had significantly thicker cortical bone at the 10-year follow-up (mean absolute difference with 95% CI:0.86 mm (0.61 mm, 1.12 mm); p <0.001). In climbers, osteophytes and clear signs of osteoarthritis were mainly seen in DIP joints. Signs of osteoarthritis according to Kellgren-Lawrence were more prevalent than 10 years before in most joints. In lateral radiographs, base osteophytes were not significantly more prevalent than 10 years before in most of the joints. The percentage of climbers who had osteophytes in any DIP (PIP) joint increased from 93.5% (67.7%) at baseline to 100% (74.2%) at the 10-year follow-up. The percentage of climbers who had clear signs of osteoarthritis according to Kellgren-Lawrence in any DIP (PIP) joint increased from 12.9% (9.7%) at baseline to 74.2% (64.5%) at 10-year follow-up. Only a few such degenerative changes were found in age-matched controls. Conclusion: An accumulation of repetitive climbing-related stress to the fingers of elite sport climbers over the career may induce lifelong mechano-adaptation of the cortical bone thickness of all phalanges. At the 10-year follow-up, a further significant increase in radiographic signs of osteoarthritic changes was observed

Semi-occlusive dressing therapy versus surgical treatment in fingertip amputation injuries: a clinical study.

OBJECTIVES Treatment of fingertip amputations is subject of controversial debates. Recently, semi-occlusive dressings have increased in popularity in these injuries. AIMS To compare clinical outcomes of conservative semi-occlusive dressing therapy versus surgical treatment of fingertip amputations. METHODS Eighty-four patients with fingertip amputations were re-examined clinically after a mean follow-up of 28.1 months (range 9.6-46.2). Sixty-six patients (79%) were treated with semi-occlusive dressings (group 1) and 18 (21%) underwent surgery (group 2). Range of motion, grip strength, and two-point discrimination were measured at the final follow-up. Furthermore, VAS score, Quick-DASH score, subjective aesthetic outcome and loss of working days were obtained. RESULTS Group 1 demonstrated healing in all 66 patients (100%) while in Group 2 5 out of 18 patients (28%) failed to achieve healing after a mean of 17 days (range 2-38) due to graft necrosis. Group 1 showed significantly lower VAS scores and significantly lower loss of two-point discrimination compared to Group 2. Work absence was significantly shorter in Group 1 versus Group 2. Trophic changes in finger (46%) and nail (30%) were significantly lower in Group 1 compared to Group 2 (44% and 70%, respectively). Disturbance during daily business activities (14%) and cold sensitivity (23%) were significantly lower in Group 1 compared to Group 2 (86% and 77%, respectively). CONCLUSIONS Semi-occlusive dressing therapy for fingertip amputations demonstrated excellent healing rates. Compared to surgical treatment, it resulted in significantly better clinical outcomes, lower complication rates and significantly higher reported satisfaction rates. Therefore, semi-occlusive dressing for fingertip injuries is a very successful procedure and shall be preferred over surgical treatment in most cases. LEVEL OF EVIDENCE III therapeutic

Three-Dimensional Planning and Patient-Specific Instrumentation for the Fixation of Distal Radius Fractures

Background and Objectives: Three-dimensional planning and guided osteotomy utilizing patient-specific instrumentation (PSI) with the contralateral side used as a reference have been proven as effective in the treatment of malunions following complex fractures of the distal radius. However, this approach has not yet been described in relation to fracture reduction of the distal radius. The aim of this study was to assess the technical and logistical feasibility of computer-assisted surgery in a clinical setting using PSI for fracture reduction and fixation. Materials and Methods: Five patients with varied fracture patterns of the distal radius underwent operative treatment with using PSI. The first applied PSI guide allowed specific and accurate placement of Kirschner wires inside the multiple fragments, with subsequent concurrent reduction using a second guide. Results: Planning, printing of the guides, and operations were performed within 5.6 days on average (range of 1-10 days). All patients could be treated within a reasonable period of time, demonstrating good outcomes, and were able to return to work after a follow-up of three months. Mean wrist movements (°) were 58 (standard deviation (SD) 21) in flexion, 62 (SD 15) in extension, 73 (SD 4) in pronation and 74 (SD 10) in supination at a minimum follow-up of 6 months. Conclusions: Three-dimensional planned osteosynthesis using PSI for treatment of distal radius fractures is feasible and facilitates reduction of multiple fracture fragments. However, higher costs must be taken into consideration for this treatment

Three-Dimensional Planning and Patient-Specific Instrumentation for the Fixation of Distal Radius Fractures

Background and Objectives: Three-dimensional planning and guided osteotomy utilizing patient-specific instrumentation (PSI) with the contralateral side used as a reference have been proven as effective in the treatment of malunions following complex fractures of the distal radius. However, this approach has not yet been described in relation to fracture reduction of the distal radius. The aim of this study was to assess the technical and logistical feasibility of computer-assisted surgery in a clinical setting using PSI for fracture reduction and fixation. Materials and Methods: Five patients with varied fracture patterns of the distal radius underwent operative treatment with using PSI. The first applied PSI guide allowed specific and accurate placement of Kirschner wires inside the multiple fragments, with subsequent concurrent reduction using a second guide. Results: Planning, printing of the guides, and operations were performed within 5.6 days on average (range of 1–10 days). All patients could be treated within a reasonable period of time, demonstrating good outcomes, and were able to return to work after a follow-up of three months. Mean wrist movements (°) were 58 (standard deviation (SD) 21) in flexion, 62 (SD 15) in extension, 73 (SD 4) in pronation and 74 (SD 10) in supination at a minimum follow-up of 6 months. Conclusions: Three-dimensional planned osteosynthesis using PSI for treatment of distal radius fractures is feasible and facilitates reduction of multiple fracture fragments. However, higher costs must be taken into consideration for this treatment

A Life Dedicated to Climbing and Its Sequelae in the Fingers-A Review of the Literature

Fingers of sport climbers are exposed to high mechanical loads. This work focuses on the fingers of a 52-year-old active elite climber who was the first in mankind to master 8B (V13), 8B+ (V14) and 8C (V15) graded boulders, bringing lifelong high-intensity loads to his hands. It is therefore hypothesized that he belongs to a small group of people with the highest accumulative loads to their fingers in the climbing scene. Fingers were analyzed by means of ultrasonography, X-rays and physical examination. Soft tissue and bone adaptations, as well as the onset of osteoarthritis and finger stiffness, were found, especially in digit III, the longest and therefore most loaded digit. Finally, this article aims to provide an overview of the current literature in this field. In conclusion, elite sport climbing results in soft tissue and bone adaptations in the fingers, and the literature provides evidence that these adaptations increase over one's career. However, at later stages, radiographic and clinical signs of osteoarthritis, especially in the middle finger, seem to occur, although they may not be symptomatic

Validity of a Novel Digitally Enhanced Skills Training Station for Freehand Distal Interlocking

Background and Objectives: Freehand distal interlocking of intramedullary nails is technically demanding and prone to handling issues. It requires precise placement of a screw through the nail under fluoroscopy guidance and can result in a time consuming and radiation expensive procedure. Dedicated training could help overcome these problems. The aim of this study was to assess construct and face validity of new Digitally Enhanced Hands-On Surgical Training (DEHST) concept and device for training of distal interlocking of intramedullary nails. Materials and Methods: Twenty-nine novices and twenty-four expert surgeons performed interlocking on a DEHST device. Construct validity was evaluated by comparing captured performance metrics—number of X-rays, nail hole roundness, drill tip position and drill hole accuracy—between experts and novices. Face validity was evaluated with a questionnaire concerning training potential and quality of simulated reality using a 7-point Likert scale. Results: Face validity: mean realism of the training device was rated 6.3 (range 4–7). Training potential and need for distal interlocking training were both rated with a mean of 6.5 (range 5–7), with no significant differences between experts and novices, p 0.234. All participants (100%) stated that the device is useful for procedural training of distal nail interlocking, 96% wanted to have it at their institution and 98% would recommend it to colleagues. Construct validity: total number of X-rays was significantly higher for novices (20.9 6.4 versus 15.5 5.3, p = 0.003). Success rate (ratio of hit and miss attempts) was significantly higher for experts (novices hit: n = 15; 55.6%; experts hit: n = 19; 83%, p = 0.040). Conclusion: The evaluated training device for distal interlocking of intramedullary nails yielded high scores in terms of training capability and realism. Furthermore, construct validity was proven by reliably discriminating between experts and novices. Participants indicate high further training potential as the device may be easily adapted to other surgical tasks

Validity of a Novel Digitally Enhanced Skills Training Station for Freehand Distal Interlocking.

Background and Objectives: Freehand distal interlocking of intramedullary nails is technically demanding and prone to handling issues. It requires precise placement of a screw through the nail under fluoroscopy guidance and can result in a time consuming and radiation expensive procedure. Dedicated training could help overcome these problems. The aim of this study was to assess construct and face validity of new Digitally Enhanced Hands-On Surgical Training (DEHST) concept and device for training of distal interlocking of intramedullary nails. Materials and Methods: Twenty-nine novices and twenty-four expert surgeons performed interlocking on a DEHST device. Construct validity was evaluated by comparing captured performance metrics-number of X-rays, nail hole roundness, drill tip position and drill hole accuracy-between experts and novices. Face validity was evaluated with a questionnaire concerning training potential and quality of simulated reality using a 7-point Likert scale. Results: Face validity: mean realism of the training device was rated 6.3 (range 4-7). Training potential and need for distal interlocking training were both rated with a mean of 6.5 (range 5-7), with no significant differences between experts and novices, p ≥ 0.234. All participants (100%) stated that the device is useful for procedural training of distal nail interlocking, 96% wanted to have it at their institution and 98% would recommend it to colleagues. Construct validity: total number of X-rays was significantly higher for novices (20.9 ± 6.4 versus 15.5 ± 5.3, p = 0.003). Success rate (ratio of hit and miss attempts) was significantly higher for experts (novices hit: n = 15; 55.6%; experts hit: n = 19; 83%, p = 0.040). Conclusion: The evaluated training device for distal interlocking of intramedullary nails yielded high scores in terms of training capability and realism. Furthermore, construct validity was proven by reliably discriminating between experts and novices. Participants indicate high further training potential as the device may be easily adapted to other surgical tasks

Anterior column acetabulum fracture fixation with a screw-augmented acetabular cup-a biomechanical feasibility study

BACKROUND: The beneficial effects of unrestricted postoperative full weight bearing for elderly patients suffering hip fractures have been demonstrated. However, there is still existing disagreement regarding acetabular fractures.The aim of this biomechanical study was to evaluate the initial load bearing capabilities of different fixation constructs of anterior column fractures (ACFs) in osteoporotic bone. METHODS: Artificial pelvises with ACFs were assigned to three groups (n = 8) and fixed with either a 7.3 mm partially threaded antegrade cannulated screw (group AASS), an anteriorly placed 3.5 mm plate (group AAPF), or a press-fit acetabular cup with screw augmentation (group AACF). All specimens underwent ramped loading from 20 N preload to 200 N at a rate of 18 N/s, followed by progressively increasing cyclic testing at 2 Hz until failure performed at a rate of 0.05 N/cycle. Relative displacements of the bone fragments were monitored by motion tracking. FINDINGS: Initial stiffness (N/mm) was 118.5 ± 34.3 in group AASS, 100.4 ± 57.5 in group AAPF, and 92.9 ± 44.0 in group AACF, with no significant differences between the groups, p = 0.544. Cycles to failure were significantly higher in groups AACF (8364 ± 2243) and AAPF (7827 ± 2881) compared to group AASS (4440 ± 2063), p ≤ 0.041. INTERPRETATION: From a biomechanical perspective, the minimally invasive cup fixation with screw augmentation demonstrated comparable stability to plate osteosynthesis of ACFs in osteoporotic bone. The results of the present study do not allow to conclusively answer whether immediate full weight bearing following cup fixation shall be allowed. Given its similar performance to plate osteosynthesis, this remains rather an utopic wish and a more conservative approach deems more reasonable