Wrist Injuries in Climbers.

BACKGROUND: Acute and chronic injuries to the wrist are among the most common sport-related complaints of climbing athletes but have not been extensively evaluated in this population. Therefore, it is important to categorize climbing injuries to the wrist, analyze risk factors, and assess treatment outcomes. PURPOSE: To evaluate the distribution, outcomes, and influencing factors of wrist injuries in climbers. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Climbing athletes with wrist injuries who presented to our specialized sports medical center over the course of 4 years (2017-2020) were selected. All had prospectively completed questionnaires including their climbing-specific background (years of training, climbing level, training methods, etc). Injuries were analyzed (International Climbing and Mountaineering Federation [UIAA] grade and diagnosis), and treatment methods and outcomes were retrospectively assessed with a minimum follow-up of 2 years. Parameters included the climbing score, visual analog scale for pain score, Patient-Rated Wrist Evaluation (PRWE) score, and shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) score including the sport component (DASH-Sport) score before and after treatment as well as time to return to climbing. RESULTS: A total of 69 patients (25 female, 44 male) with 78 wrist injuries were identified and analyzed. Of these, 7 injuries were bilateral, occurring at the same time, and 2 injuries were independent reinjuries to either the same or the contralateral side. In addition, 24 injuries (30.8%) were acute, while 54 (69.2%) were chronic. Overall, 2 injuries had a UIAA grade of 3; all others had a UIAA grade of 2. The most frequent injuries were synovitis of the ulnocarpal recess, ulnar impaction, bone marrow edema of the lunate, wrist sprains (joint capsular pain with stress, with no pathological finding on magnetic resonance imaging), and wrist ganglion cysts. Nonoperative treatment was performed for 61 of the injuries, while 17 were treated surgically. In 51 cases (65.4%), injuries healed without consequences; in 27 cases (34.6%), discomfort remained. The visual analog scale pain score decreased from 4.8 ± 1.9 before treatment to 0.7 ± 1.0 after treatment (P < .001), the PRWE score decreased from 53.6 ± 24.9 to 10.3 ± 13.1 (P < .001), the QuickDASH score improved from 53.0 ± 16.6 to 20.0 ± 20.2 (P < .001), and the DASH-Sport score improved from 82.0 ± 16.1 to 38.1 ± 23.5 (P < .001). The climbing score improved from 2.5 ± 1.1 to 4.3 ± 1.0 points (P < .001). The patient-reported number of days with pain was negatively correlated with changes in the PRWE score (r = -0.351; P < .001), QuickDASH score (r = -0.316; P = .007), and climbing score (r = -0.264; P = .025) as well as the number of days without climbing (r = -0.266; P = .025). The number of days without climbing was positively correlated with changes in the PRWE score (r = 0.369; P < .001). CONCLUSION: Wrist injuries in climbers constituted a diverse set of diagnoses. Ulnar-sided injuries were most common, and many patients had >1 diagnosis. Outcomes for all treatment methods (surgery and nonoperative care) were favorable, but approximately one-third of climbers had persistent wrist discomfort after treatment, underscoring the need for accurate diagnoses and acute and expert care.

Double-level torsional osteotomy a treatment for the 'inwardly pointing knee' syndrome.

INTRODUCTION: A 'inwardly pointing knee' syndrome is a combined torsional deformity with increased femoral internal and tibial external torsion. After clinical and radiological verification of the torsional deformity and unsuccessful conservative therapy approach, a combined (double level) torsional osteotomy of femur and tibia might be the appropriate treatment. Here, we present the diagnostic algorithms, treatment, and outcome of combined torsional osteotomies of femur and tibia. The aim of the study is to show that patients treated with the procedure achieve patellofemoral stability and pain relief or reduction. MATERIAL AND METHODS: Twenty torsional osteotomies performed on 18 patients were included. Nine patients had experienced patellar dislocation in 11 joints before. All patients were suffering from anterior knee pain. All patients underwent a clinical and radiographical evaluation, including a torsion angle CT scan. Pre- and post-operatively multiple commonly approved scores (Lysholm Score, Tegner Activity score, Kujala Score, VAS and Japanese Knee Society score) were acquired. RESULTS: In 18 patients we performed 20 double-level torsional osteotomies. 9 patients suffered from patellar dislocations in 11 knee joints prior to surgery. All patients were suffering from anterior knee pain. Of these 7 patients achieved a stable joint after surgery without further patellar dislocations. All achieved more knee stability and experienced less patellar luxation then before surgery. The mean duration of follow-up was 59 months (range 9-173 months). The mean VAS was significantly reduced by 3.75 points (SD 2.09, p value 0.0002) from 5.50 points (SD 2.73, range 0-9) before surgery to 1.75 points (SD 1.67, range 0-5) after surgery. The Lysholm score increased significantly by mean of 27.6 (SD 17.55, p value 0.0001) from mean 62.45 (SD 22.71, range 22-100) before surgery to mean 90.05 (SD 10.18, range 66-100) after surgery. The Kujala Score did improve significantly in average by 25.20 points (SD 13.61, p value 0.00012) from mean 62.9 (SD 16.24, range 35-95) to mean 93.2 (SD 9.20, range 66-100). The Tegner activity score did increase significantly by 1.2 points (SD 1.47, p value 0.004) in average from mean 2.65 (SD 1.11, range 1-5) to mean 3.85 (SD 1.42, range 1-6). The Japanese knee score did increase significantly by 19.15 in average (SD 11.95, p value 0.0001) from mean 74.05 (SD 14.63, range 33-95) to mean 93.05 (SD 10.18, range 68-100). CONCLUSION: This is the first publication reporting about simultaneous double-level torsional osteotomies in a comparatively high number of patients. In addition, this is the first publication assessing the patient collective afterwards with objectifying clinical outcome scores. The results show that double-level torsional osteotomy is an effective treatment for patients with patellar dislocation or subluxation associated to torsional deformities of femur and tibia. Furthermore, we introduce a diagnostic algorithm for 'inwardly pointing knee' syndrome. LEVEL OF EVIDENCE: Level IV.