Risk Factors for Musculoskeletal Injury in CrossFit: A Systematic Review.

The objective of this systematic review was to identify potential risk factors for injury in CrossFit participants. Embase, Medline, Web of Science, Cochrane, CINAHL, Google Scholar, and SportDiscuss databases were all searched up to June 2021. Cohort studies that investigated risk factors for CrossFit injuries requiring medical attention or leading to time loss in sports were included. A best-evidence synthesis was performed combining all the outcomes from prospective cohort studies. From 9,452 publications identified, we included three prospective cohort studies from which two had a low risk of bias and one a high risk of bias. The studies examined 691 participants of whom 172 sustained an injury. There was limited evidence that switching between prescribed and scaled loads during training is associated with increased injury risk and that increased duration of participation is a protective factor for injury. This could mean that novice CrossFit athletes and those increasing their training load should have closer supervision by CrossFit coaches. These risk factors should be considered when developing preventive interventions.

Posttraumatic Osteoarthritis of the Distal Interphalangeal Joint: A Follow-Up Study of 12 Years After Nonsurgical Treatment of Mallet Finger Fractures.

PURPOSE: In treatment of mallet finger fractures (MFFs), the aim is to minimize residual extension lag, reduce subluxation, and restore congruency of the distal interphalangeal (DIP) joint. Failure to do so may increase the risk of secondary osteoarthritis (OA). However, long-term follow-up studies focusing on OA of the DIP joint after an MFF are scarce. The purpose of this study was to assess OA, functional outcomes, and patient-reported outcome measures (PROMs) after an MFF. METHODS: A cohort study was performed with 52 patients who sustained an MFF at a mean of 12.1 years (range, 9.9-15.5 years) previously and who were treated nonsurgically. A healthy contralateral DIP joint was used as the control. Outcomes were radiographic OA, using the Kellgren and Lawrence and Osteoarthritis Research Society International classifications, range of motion, pinch strength, and PROMs (Patient-Rated Wrist Hand Evaluation, Quick Disabilities of the Arm, Shoulder, and Hand, Michigan Hand Outcome Questionnaire, 12-item Short Form Health Survey). Radiographic OA was correlated with PROMs and functional outcomes. RESULTS: At follow-up, there was an increase in OA in 41% to 44% of the MFFs. Of all the MFFs, 23% to 25% showed a higher degree of OA than the healthy control DIP joint. Range of motion (mean difference ranging from -6° to -14°) and Michigan Hand Outcome Questionnaire score (median difference, -1.3) were decreased after MFFs but not to a clinically relevant extent. Radiographic OA was weakly to moderately correlated with functional outcomes and PROMs. CONCLUSIONS: Radiological OA after an MFF is similar to the natural degenerative process in the DIP joint and is accompanied by a decrease in range of motion of the DIP joint, which does not clinically affect PROMs. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

External validation of the Almelo Hip Fracture Score, a prediction model for early mortality following hip fracture surgery.

PURPOSE: Early mortality (< 30 days) in hip fracture patients is as high as 9.6%. Several risk assessment tools have been developed to identify patients at high risk for early mortality. Among them, the Almelo Hip Fracture Score (AHFS) was developed recently and showed promising results. Until now, this tool has not been validated; therefore, we aim to perform an external validation of the AHFS. METHODS: On admission, AHFS variables were prospectively collected. The prospectively collected data were used retrospectively to externally validate the AHFS in a cohort of hip fracture patients that were admitted to a hospital in Delft (Delft cohort). The AHFS score was retrospectively calculated for all hip fracture patients meeting the inclusion criteria. The characteristics of the Delft Cohort, AHFS score, sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve were calculated and compared to the original Almelo cohort, in which the AHFS was developed. RESULTS: 422 patients of 70 years and older were included. Mortality within 30 days was 7.6% and similar to the 7.5% observed in the Almelo cohort. For the high-risk cut-off point, specificity was 95.4% in the Delft Cohort vs. 92.5% in the Almelo Cohort, and sensitivity for the low-risk cut-off point was 75.9 vs. 78.1% in the Almelo Cohort. The area under the ROC curve was 0.70 (95% CI 0.60-0.79) compared to 0.82 in the Almelo cohort. CONCLUSIONS: The validity of the score was acceptable and comparable to the values in the Almelo cohort. This score might be used to identify patients at high risk for early mortality.

The Correlation of Shoe Size and Component Size of Primary Total Knee Arthroplasty.

Preoperative planning is an important phase of total joint arthroplasty. Current template programs and methods only provide moderate accuracy for implant size prediction. Recently, a relationship between shoe size and implant size was found. We hypothesized that shoe size shows a high percentage of agreement for implant size of both femoral and tibial component size in primary total knee arthroplasty (TKA). The aim of this study was to investigate the correlation and agreement between shoe size and TKA implant size. We performed a retrospective cohort study. Of all patients, who underwent primary TKA between September 2013 and March 2016, shoe size and knee implant sizes were collected. Cross-tabulation was used to determine the correlation and agreement between shoe size and implant size. A total of 489 patients (498 TKA) were included. The correlation coefficient for femoral and tibial component with shoe size was 0.751 and 0.759, respectively. When a deviation of ± 1 component size was allowed, shoe size gave at least 94% agreement score for femoral component and at least 86% agreement score in tibial component. We conclude that both femoral and tibial component size have a good correlation with shoe size. Therefore, shoe size may be used as a valuable predictor in preoperative implant size planning for primary TKA. The level of evidence for this study was Level IV.