Efficacy of corticosteroid injection in rock climber's tenosynovitis.

While many finger conditions in climbers have been studied extensively, no data exist on the treatment of rock climber's finger flexor tenosynovitis. The purpose of this study was to evaluate the outcomes after corticosteroid injection. The study included rock climbing athletes suffering from chronic (longer than 6 weeks) finger flexor tenosynovitis who were seen at our clinic in 2017. All 42 patients received two corticosteroid injections within a 7-10 day period. Thirty-one climbers (73.8%) were pain free after the second injection and a mean of 20.9±23.1 days. The climbers reported an 84.2% decrease in pain level and no complications. The positive outcome after corticosteroid injection therapy and the absence of complications justifies this invasive approach in rock climbing athletes.

[Osteosynthesis of displaced fractures of the greater tuberosity with the Bamberg plate]. / Osteosynthese dislozierter Tuberculum-majus-Frakturen mit der Bamberger Platte.

OBJECTIVE: Internal fixation of displaced fractures of the greater tuberosity allowing functional aftercare. INDICATIONS: Displaced fractures of the greater tuberosity >5 mm. Displaced fractures of the greater tuberosity >3 mm in athletes or overhead workers. Multiply fragmented fractures of the greater tuberosity. CONTRAINDICATIONS: Displaced 3­ or 4­part fractures of the proximal humerus. Nondisplaced fractures of the greater tuberosity. SURGICAL TECHNIQUE: Exposure of the fracture of the greater tuberosity by an anterolateral approach. Open reduction and temporary retention with a Kirschner wire or a "Kugelspieß" or reinforcement of the supraspinatus tendon and distal retention. Bending and positioning of the Bamberg plate and fixation by conventional or locking screws. Optional fixation of the rotator cuff to the plate. Exact monitoring of the implant position using the image intensifier to avoid inadequate distalization of the greater tuberosity. POSTOPERATIVE MANAGEMENT: Arm sling (e. g. Gilchrist) for 2 weeks. Start passive assisted exercise on postoperative day 1. Movement allowed up to the pain threshold. Physiotherapeutic treatment to prevent adhesions and capsular shrinking. RESULTS: In all, 10 patients with displaced fractures of the greater tuberosity underwent osteosynthesis using the Bamberg plate. After a follow-up of at least 6 months, a Constant-Murley score of 94.2  points (range 91-98 points) was achieved. The patients' average age was 45.6 years (range 29-68 years).

Surgical repair of multiple pulley injuries--evaluation of a new combined pulley repair.

PURPOSE: We report on a combined repair of multiple annular pulley tears using 1 continuous palmaris longus tendon graft to restore strength and function. METHODS: We treated 6 rock climbers with grade 4 pulley injuries (multiple pulley injuries) using the combined repair technique and re-evaluated them after a mean of 28 months. RESULTS: All patients had excellent Buck-Gramcko scores; the functional outcome was good in 4, satisfactory in 1, and fair in 1. The sport-specific outcome was excellent in 5 and satisfactory in 1. Proximal interphalangeal joint flexion deficit slightly increased in 1 patient and remained the same in the other 5. Climbing level after the injury was the same as before in 4 and decreased slightly in 2 climbers. CONCLUSIONS: The technique is effective with good results and has since become our standard treatment. Nevertheless, it is limited in patients with flexion contracture of the proximal interphalangeal joint. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.

[PACS: acceptance by orthopedic surgeons]. / PACS: Akzeptanz bei Orthopäden und Unfallchirurgen.

PURPOSE: The goal of the study was to evaluate the acceptance of a web-based picture archiving and communication system (PACS) by orthopedic surgeons 1 year after implementation. MATERIALS AND METHODS: One year after the implementation of a web-based PACS all physicians were surveyed with a standardized questionnaire. Questions included: speed of PACS, quality of clinicoradiological meetings, quality of monitors, PACS training, and performance. Data were evaluated separately for the Department of Orthopedic Surgery and the reference group of all other physicians. RESULTS: Among the respondents, 92% of the orthopedic surgeons stated there was a reduction of time required to receive images, and 64% concluded that patient care was faster. Archived images were received in less than 5 min in 82% after PACS and in 8% before PACS. The clinicoradiological meetings improved with PACS in 100% due to beamer presentation. All would recommend a PACS. The equipment to view images in the operating theater was assessed as being good or very good by 83%; monitor quality was judged better for the outpatient clinics (100% good or very good). Conventional radiograms were missed at the ward rounds by 56%. Training for PACS was considered sufficient by 67%, and 15% asked for refresher courses. In the reference group 60% asked for refresher courses. In the comparison of orthopedic surgeons with the reference group PACS was judged better especially concerning the viewing software and quality of monitors. CONCLUSION: There is an over all acceptance of PACS by physicians outside the radiology department. The availability of images was not only facilitated it was faster as well. However, the quality of monitors in the operating theater should be improved. To achieve sustained success of PACS consistent training on PACS and its features is necessary. Conventional radiograms were often missed at the ward rounds.

[Sports ability after patella dislocation]. / Sportfähigkeit nach Patellaluxation.

A dislocation of the patella is a serious injury which can far affect the career of every athlete or even finish it. In a retrospective study we examined 24 athletes (mean age 19.3 years, post surgical observation period 39 (13 to 79) months) which suffered from a patellar dislocation and received arthroscopic surgical treatment. The diagnostics contained clinical investigation and X-rays of the knee joint in 2 plains as well as patella tangential, in pathological axial deformations of the leg completed with whole-leg-images and optional a torsion computed tomography. All 24 patients received an arthroscopical assisted suturing of the medial retinaculum, in 12 patients additional a lateral release was carried out. The postoperative course followed a standard pattern. In 24 operated patients the reoccurrence rate was 12.5 % (3 patients), which is within the range of the latest published figures (average 12.0 %). The Lysholm score was in 15 (62.4 %) of all patients higher than 80 demonstrating the good to very good results, the average Lysholm score was 83.4. Out of 24 patients with patellar dislocation 11 patients (45.8 %) were able to continue their sport career after surgical therapy at the pre-trauma level, 4 patients (16.6 %) had to continue at lower level, 9 patients (37.5 %) had to finish their sport career. The Tegner activity score decreased from 7.2 to 6.0 at about 1.2 points what means a clear decrease of the activity level. On average a full sportive level was reached 9.7 months after surgery. Especially sport athletes needs to be informed about the seriousness of the injury and the long process of rehabilitation.