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

Mid- to long-term clinical and radiological results of anatomic total shoulder arthroplasty in patients with B2 glenoids

BACKGROUND: Eccentric biconcave (B2) glenoid erosion in primary glenohumeral arthritis is common. There are serious concerns regarding the longevity of fixation of cemented glenoids if anatomic total shoulder arthroplasties (aTSAs) are used in B2 glenoid. The purpose of this study is to analyze the mid- to long-term results of aTSA with B2 glenoids. METHODS: This is a retrospective study of a single center experience. Thirty patients (32 shoulders) at an average of 9.2 years (range, 5.0-16.6, ±3.2) after primary TSA were evaluated. Clinical and radiographic outcomes were analyzed. RESULTS: The mean preoperative intermediate glenoid version was -14° ± 7° (range, -2° to -29°) and the mean humeral subluxation according to the plane of the scapula was 67% ± 9% (range, 49%-87%). There was a significant improvement for all the postoperative clinical outcome parameters including the mean absolute and relative Constant Score, subjective shoulder value, active elevation, external rotation, abduction, internal rotation, pain scores, and strength (P < .001). The complication rate was 15.6% and the revision rate was 12.5% at a mean follow-up of 9.2 years (range, 5.0-16.6, ±3.2). The estimated survivorship without revision was 94% at 5 years and 85% at 10 years (12.1-14.7 years). The survival rate without advanced glenoid component loosening (defined as Lazarus grade ≥ 4 or modified Molé scores ≥ 6) was 91% at 5 years and 84% at 10 years (12.2-15.8 years). CONCLUSION: In this case series, aTSA with asymmetric reaming for the treatment of shoulder osteoarthritis with milder forms of B2 glenoid is a viable option with good to excellent clinical results and an 85% prosthetic survivorship at 10 years

Quality of reduction correlates with clinical outcome in pelvic ring fractures

INTRODUCTION Posttraumatic pelvic deformity is associated with pain and loss of function. This study aimed to test the correlation of functional outcome in patients with pelvic fractures with the postoperative radiographic quality of reduction. METHODS Consecutive patients with an isolated traumatic pelvic fracture that required closed or open reduction between 07/2015 and 07/2017 and had a completed follow-up of at least 6 months were included (N = 31, mean age 50 years, SD 21 years, range, 16 to 88 years). Majeed and Timed Up & Go were obtained from a prospective outcome database at 6 months and last follow-up (mean 10 months, SD 5 months). Quality of pelvic ring reduction was determined on postoperative radiographs as described by Matta, Sagi and Keshishyan/Lefaivre. RESULTS Clinical outcome at 6 months as measured by the Majeed and the Timed Up & Go correlated moderately with Keshishyan/Lefaivre's pelvic asymmetry value (Pearson R: -0.520 and 0.585, p ≤ 0.003) and the pelvic deformity index (-0.527 and 0.503, p ≤ 0.004). There was a weak correlation between the Timed Up & Go and the radiographic grading system as described by Matta/Tournetta at 6 months (0.408, p = 0.023) and at last follow-up (0.380, p = 0.035). CONCLUSIONS This study showed a moderate correlation of the clinical outcome at 6 months with postoperative quality of radiographic reduction when measured with the method described by Keshishyan and Lefaivre. Although having only descriptive value due to the small cohort, our findings underline the importance of anatomic reduction and restoration of pelvic symmetry in patients with pelvic trauma. Future studies with more patients and more investigators are required and reliability and validity of functional outcome scores needs to be further assessed to predict outcome in patient with fractures of the pelvic ring. LEVEL OF EVIDENCE Level IV (case series)

Is a Washer a Mandatory Component in Young Trauma Patients with S1-S2 Iliosacral Screw Fixation of Posterior Pelvis Ring Injuries? A Biomechanical Study

Background and purpose: Cannulated screws are standard implants for percutaneous fixa-tion of posterior pelvis ring injuries. The choice of whether to use these screws in combination with a washer is still undecided. The aim of this study was to evaluate the biomechanical competence of S1-S2 sacroiliac (SI) screw fixation with and without using a washer across three different screw designs. Material and Methods: Twenty-four composite pelvises were used and an SI joint injury type APC III according to the Young and Burgess classification was simulated. Fixation of the posterior pelvis ring was performed using either partially threaded short screws, fully threaded short screws, or fully threaded long transsacral screws. Biomechanical testing was performed under progressively increasing cyclic loading until failure, with monitoring of the intersegmental and bone-implant movements via motion tracking. Results: The number of cycles to failure and the corresponding load at failure (N) were significantly higher for the fully threaded short screws with a washer (3972 ± 600/398.6 ± 30.0) versus its counterpart without a washer (2993 ± 527/349.7 ± 26.4), p = 0.026. In contrast, these two parameters did not reveal any significant differences when comparing fixations with and without a washer using either partially threaded short of fully threaded long transsacral screws, p ≥ 0.359. Conclusions: From a biomechanical perspective, a washer could be optional when using partially threaded short or fully threaded long transsacral S1-S2 screws for treatment of posterior pelvis ring injuries in young trauma patients. Yet, the omission of the washer in fully threaded short screws could lead to a significant diminished biomechanical stability