A Biomechanical Analysis of the H-Taping Method Used by Rock Climbers as Prophylactic or Stabilizing Fixation of Partial A2 Pulley Tears.

PURPOSE: Rock climbing can lead to upper-extremity injuries, such as A2 pulley ruptures, leading to the bowstringing of the flexor tendons. Climbing finger positions are specific and can put undue stress on the pulley systems. This causes severe hand dysfunction and is a difficult problem to treat, and prevention is important. Using a cadaveric, experimental model, we evaluated the effectiveness of the H-taping method, commonly used by rock climbers, to prevent and treat A2 pulley tears. METHODS: Using fourteen matched pairs of fresh-frozen cadaveric hands with forearms, four experiments were conducted with 56 paired comparisons evaluating the failure force, fingertip force, and mode of failure (112 total tests). Comparisons were as follows: index fingers- intact versus 50% distal A2 pulley tears without H-taping (control); ring fingers- intact versus H-taping as a prophylactic for A2 pulley tears; little fingers- 50% distal A2 pulley tears with H-tape versus without tape; and middle fingers- H-taping as a prophylactic versus H-taping as a stabilizing treatment of torn pulleys. RESULTS: The mean index finger failure force was significantly higher in intact vs torn A2 pulleys (control). Failure force for intact H-taped fingers was significantly higher than torn H-taped fingers, but no other finger comparisons for failure force were significant. There were no significant findings in comparison of mean fingertip force values in any of the experiments. CONCLUSIONS: We found that H-taping is not effective as prophylaxis against A2 pulley ruptures or as a stabilizing treatment method for partially ruptured pulleys. CLINICAL RELEVANCE: While H-taping has not been recommended as prophylaxis for preventing A2 pulley ruptures, the climbing community has embraced this technique as a preventative measure. The present study provides biomechanical evidence against H-taping for this purpose. Furthermore, it does not appear to aid in increasing fingertip force after injury.

Objective Evaluation of Motor Skills for Orthopedic Residents Using a Motion Tracking Drill System: Outcomes of an ABOS Approved Surgical Skills Training Program.

BACKGROUND: Orthopedics is a motor skills-demanding surgical specialty requiring surgical skills training outside of the operating room. Unfortunately, limited quantitative techniques exist to determine the effectiveness of these surgical skills training programs. Using a variety of drill, surgeon, and specimen mounted sensors, we evaluated orthopedic surgery residents during a surgical skills training course approved by the American Board of Orthopaedic Surgeons (ABOS). This evaluation consisted of quantitative measures of various kinematic and kinetic parameters with the goal of relating these to clinically-significant outcomes. METHODS: Seven experienced surgeons and 22 surgical residents participated in this study, each performing 5 surgical drilling trials, pre- and post-training. Utilizing arm and tool kinematics, applied force, tool and bone vibration, and drill RPM were measured using a combination of force, acceleration, and optical tracking sensors. Post hoc screw pullout testing and resident survey data were also evaluated. Overall, 25 measured parameters were expressed as scalars and their covariance calculated. RESULTS: Non-trivial direct correlations whose magnitude exceeded 0.5 were: maximum penetration distance with applied force, drill toggle with drill roll angle, and drill RPM with force. Surgeons applying a high drill RPM also yielded a large force which in turn gave an increase in tendency for over-penetration. As a whole, the differences between experienced and novice surgeons measured in these trials were not statistically significant. However, when looking at specific performance criterion individually (maintaining steady force, minimizing over-penetration, minimizing both the major and minor axis diameters, minimizing toggle and drill vibration), experienced surgeons tended to outperform their novice counterparts. CONCLUSIONS: Objective assessment of surgical skills using sensor based technologies may help elucidate differences between novice and experienced surgeons for improved out-of-the-OR training methodologies.