Validity and Reliability of Finger-Strength Testing in 6 Common Grip Techniques for the Assessment of Bouldering Ability in Men.

OBJECTIVE: To determine the criterion validity and test-retest reliability of isometric finger-strength testing in 6 differentiated grip techniques for the assessment of bouldering ability among male climbers. METHODS: We recruited participants at climbing gyms in Sweden and through online advertisements. We included climbers over 15 years of age with a minimum bouldering performance level of 17 International Rock Climbing and Research Association (IRCRA) for men and 15 IRCRA for women. We tested unilateral, maximal isometric peak finger strength in the front 3 drag, half crimp, closed crimp, 35 sloper, 45 × 90-mm, and 90 × 90-mm pinch through maximal force deloaded of a force plate. We analyzed criterion validity, test-retest reliability, and capacity to determine bouldering performance ability using a stepwise multivariable regression model. RESULTS: Women were excluded from the analysis due to insufficient sample size (n = 16). Thirty-two male participants were included in the primary analysis. The median (interquartile range) age in the advanced and elite group was 27 (25; 35) and 23 (22; 32) years, respectively. The half crimp for the participants' weak and strong hand displayed the highest ability to determine bouldering grade performance, explaining 48% to 58% of the variance. In the stepwise regression, maximal strength in the half crimp and the front 3 drag collectively explained 66% of the variance for performance. CONCLUSION: Strength in the half crimp proved the most important performance indicator. The results of this study provide a reliable and valid framework for maximal isometric peak finger-strength testing in advanced and elite male boulderers.

Mental health problems, sleep quality and overuse injuries in advanced Swedish rock-climbers - the CLIMB study.

OBJECTIVES: To examine the prevalence of mental health problems (depression, anxiety, and stress), sleep quality, and disability due to overuse injuries in advanced and elite rock-climbers. The rock-climbers were compared to a group of non-climbing controls. METHODS: A self-selected sample of advanced and elite Swedish rock-climbing athletes was recruited through the Swedish Rock-climbing Federation, local rock-climbing gyms and through social media. A control group, matched in size was recruited. Participants in the control group answered an online survey of validated questionnaires, examining symptoms of stress, anxiety, depression, sleep quality. The climbing participants answered the same survey as the non-climbing controls but with additional questions regarding musculoskeletal problems and disabilities related to these. Outcome measures used were the Depression Anxiety Stress Scale, Pittsburgh Sleep Quality Index and The Oslo Sports Trauma Research Center Overuse Injury Questionnaire. RESULTS: A total of 183 participants were included in the rock-climbing group, and 180 participants in the control group. In the rock-climbing group the mean age (SD) was 28.2 (8.3) years among women and 30.5 (9.6) years in men. The mean BMI of women was 21.2 (2.2) and 22.8 (2.1) in men. A total of 30.6% of the rock-climbing group (26.7% of men, 35.9% of women) reported at least moderate levels of symptoms of depression and 23.1% (17.2% men, 30.8% women) at least moderate levels of symptoms of anxiety. A total of 48.4% of rock-climbers (39.1% men, and 61.6% women) reported at least moderate levels of symptoms of stress. Among the rock-climbers, 45.0% reported having poor sleep quality. There were no statistical significant differences (p = 0.052-0.96) in mental health problems or sleeping problems between the rock-climbers and the controls. Among rock-climbers, reports of one-week prevalence of injury related problems was: Finger and hand (49.5%), Shoulder (35.2%), Knee (29.1%), Lumbar back (26.4%), Arm (25.3%), Thoracic back and neck (17.0%), and Foot and lower leg (12.1%). CONCLUSION: The overall results indicate high levels of symptoms of mental health problems and poor sleep quality in both rock-climbers and controls. Although no significant differences between the climbing group and the control group was displayed, symptoms that warrant clinical attention is high. Overuse injuries were commonly reported among the rock-climbers in all examined injury locations. Previous studies reporting mental health problems to be more prevalent among athletes were contradicted in this study. The results display the need for a broader perspective regarding climbers general health and the need to provide structured care and adequate support in order to come to terms with these concerns.

Protocol for a 2-year longitudinal study of eating disturbances, mental health problems and overuse injuries in rock climbers (CLIMB).

INTRODUCTION: Rock climbing is a rapidly growing sport in which performance may be affected by participant's weight and leanness, and there may be pressure on athletes with respect to their eating behaviour and body weight. However, there is sparse research performed on climbers, constituting a knowledge gap which the present study aims to fill. The primary outcomes of the study are to examine disordered eating and overuse injuries in rock climbers. Secondary variables are body image, indicators of relative energy deficiency, mental health problems, compulsive training, perfectionism, sleep quality and bone density. METHOD AND ANALYSIS: This prospective longitudinal study aims to recruit Swedish competitive rock climbers (>13 years) via the Swedish Climbing Federation. A non-athlete control group will be recruited via social media (n=equal of the climbing group). Data will be collected using streamlined validated web-based questionnaires with three follow-ups over 2 years. Inclusion criteria for rock climbers will be a minimum advanced level according to International Rock-Climbing Research Association. The non-athlete control group is matched for age and gender. Exclusion criteria are having competed at an elite level in any sport as well as training more often than twice per week. Statistical analyses will include multinominal logistic regression, multivariate analysis of variance (MANOVA) and structural equation modelling (SEM). We will assess effect measure modification when relevant and conduct sensitivity analyses to assess the impact of lost to follow-up. ETHICS AND DISSEMINATION: The Rock-Climbers' Longitudinal attitudes towards Injuries, Mental health and Body image study, CLIMB, was approved by the Swedish ethics authority (2021-05557-01). Results will be disseminated through peer-reviewed research papers, reports, research conferences, student theses and stakeholder communications. TRIAL REGISTRATION NUMBER: NCT05587270.

The Ambiguity of Names and Landmarks in Radiographs of the Pediatric Pelvis: Variations and a Historical Perspective.

For over a century, the plain radiograph has been used to measure and predict the development of pediatric hip conditions. Classic measurements, such as the acetabular index, the center-edge angle, and the migration percentage, have stood the test of time and remain the default tools for any pediatric orthopaedic surgeons. However, in contemporary research, the terminology regarding these measurements has become markedly inconsistent. A substantial number of synonyms, acronyms, and similar, but not identical, terms are used to label measurements. This is perhaps unsurprising, considering decades of use and numerous suggested modifications. The results of treatment cannot be reliably compared if the measured parameters are not identical, and scientific analysis of disease requires consistent terminology. In this review, we aim both to provide historical definitions and identification of radiographic landmarks commonly used in three parameters of interest on pediatric AP radiographs and to examine the variability of landmarks and definitions in contemporary research.

Low occurrence of MRI spinal changes in elite climbing athletes; a cross-sectional study.

OBJECTIVES: To examine the occurrence of magnetic resonance imaging (MRI) changes in the thoracolumbar spine among elite climbing athletes. METHODS: All climbers of the Swedish national sport climbing team (n = 8), and individuals having trained for selection to the national team (n = 11), were prospectively included. A control group, matched in age and sex, were recruited. All participants underwent a thoracolumbar MRI (1.5 T, T1- and T2-weighted imaging), evaluated according to Pfirrmann classification, modified Endplate defect score, Modic changes, apophyseal injuries and spondylolisthesis. Pfirrmann ≥ 3, Endplate defect score ≥ 2 and Modic ≥ 1 was defined as degenerative findings. RESULTS: Fifteen individuals, 8 women, participated in both the climbing group (mean age 23.1, SD 3.2 years) and the control group respectively (mean age 24.3, SD 1.5 years). In the climbing group, 6.1% of the thoracic and 10.6% of the lumbar intervertebral discs showed signs of degeneration according to Pfirrmann. One disc with a grade above 3 was present. Modic changes in the thoracic/lumbar spine were prevalent in 1.7%/1.3% of the vertebrae. Degenerative endplate changes according to the Endplate defect score were found in 8.9% and 6.6% of the thoracic and lumbar spinal segments of the climbing group, respectively. Two apophyseal injuries were found, while no participants displayed signs of spondylolisthesis. There was no difference in point-prevalence of radiographic spinal changes between climbers and controls (0.07 < p < 1.0). CONCLUSION: In this small cross-sectional study, only a low proportion of elite climbers displayed changes of the spinal endplates or intervertebral discs, as opposed to other sports with high spinal loads. Most observed abnormalities were low grade degenerative changes and did not differ statistically compared to controls.

Postoperative stability following a triple pelvic osteotomy is affected by implant configuration: a finite element analysis.

BACKGROUND: The triple pelvic osteotomy is an established surgical method with multiple modifications regarding surgical technique and choice of implant. The stability of the osteotomy is affected by numerous factors, and among these, the three-dimensional implant configuration is a scientifically less explored aspect. METHODS: We used a finite element model of a hemi-pelvis with a standardized triple osteotomy to calculate relative flexibility for loads in all translational degrees of freedom for five different implant configurations. Two of the configurations used entry points only feasible when implant removal was not necessary. RESULTS: The stability of the osteotomy improved with an increased distance between the implants in the plane of the osteotomy as well as for a more perpendicular angle relative to the osteotomy plane. The implant configurations with more entry points available made this easier to adhere to. CONCLUSION: The use of bioabsorbable implants may provide better opportunities for optimal implant constructs which can, to a certain degree, compensate for the lesser mechanical stiffness of bioabsorbable polymers as compared to metal implants.

Patterns of traumatic outdoor rock-climbing injuries in Sweden between 2008 and 2019.

PURPOSE: Injury prevalence patterns for climbers have been presented in several papers but results are heterogenous largely due to a mix of included climbing disciplines and injury mechanisms. This study describes the distribution and pattern of acute traumatic climbing injuries sustained during outdoor climbing in Sweden. METHODS: Patients that experienced a climbing related traumatic injury during outdoor climbing between 2008 and 2019 and who submitted a self-reported questionnaire to the Swedish Climbing Association were included in the study. Medical records were retrieved, and the International Climbing and Mountaineering Federation injury classification system was used for injury presentation. RESULTS: Thirty-eight patients were included in the study. Seven (18%) injuries occurred during traditional climbing, 13 (34%) during sport climbing and 9 (24%) during bouldering. Varying with climbing discipline, 84-100% injuries were caused by falls. Injuries of the foot and ankle accounted for 72-100% of the injuries. Fractures were the most common injury (60%) followed by sprains (17%) and contusions (10%). CONCLUSIONS: Traumatic injuries sustained during outdoor climbing in Sweden were predominantly caused by falls and affected the lower extremities in all major outdoor climbing disciplines. Rope management errors as a cause of injury were common in sport climbing and in activity surrounding the climbing, indicating there is room for injury-preventing measures.

Stability in Pelvic Triple Osteotomies in Children Using Resorbable PLGA Screws for Fixation.

BACKGROUND: The triple pelvic osteotomy (TPO) is a major redirectional osteotomy used to improve the acetabular coverage of the femoral head in selected pediatric patients with hip disorders. Traditionally the iliac osteotomy is stabilized by metal screws that require a second surgery for removal. Despite favorable results for both adults and children in related pelvic osteotomies, resorbable implants have not previously been used for TPOs.This study aims to suggest a novel modified TPO surgical method in children using resorbable poly lactic-co-glycolic acid (PLGA) screws for fixation and to radiographically evaluate the postoperative stability achieved by these implants in a case series. METHODS: All patients (n=11) with dysplasia of the hip (2), Perthe disease (5), or Down syndrome (4), who underwent primary TPO surgery during 2013 to 2019, using resorbable PLGA screws for fixation were included. The stability of the osteotomy was evaluated in the postoperative radiograph series using the acetabular index, migration percentage, Sharp's angle and the center-edge angle. The osteotomy angle was introduced as a parameter to confirm the postoperative integrity of the achieved correction. All cases were evaluated until radiographic healing of the iliac osteotomy. Hospital notes were analyzed for complications or local reactions in relation to the implants. RESULTS: In all studied hips, the overall achieved correction was well maintained. The mean (SD) correction achieved, from the preoperative images to the last measurable postoperative image, was a 16.7 degrees decrease for Sharp angle, a 20.9 degrees decrease in acetabular index and a 24.7 degrees increase for the center-edge angle, respectively. There were no complications related to the bioabsorption of the implants. CONCLUSION: The present findings suggest that the modified TPO method, using resorbable PLGA screws, provides sufficient stability and appears to be a promising alternative to traditional TPO. Avoiding implant removal is a major benefit in a pediatric population. Resorbable screws enable the surgeon to place implants with more degrees of freedom since later implant removal is not a limiting factor. LEVEL OF EVIDENCE: Level IV-case series.

MRI evaluation of resorbable poly lactic-co-glycolic acid (PLGA) screws used in pelvic osteotomies in children-a retrospective case series.

PURPOSE: The orthopaedic use of resorbable poly lactic-co-glycolic acid (PLGA) implants carries multiple potential benefits. To our knowledge, only one publication exists regarding the use of PLGA implants in pelvic osteotomies in children, and data regarding resorption and potential side effects are lacking for resorbable pelvic screws in children. The aim of this study is to present an MRI-based evaluation of the resorption pattern and local tissue reactions in a paediatric case series after pelvic osteotomies fixated with PLGA screws. METHODS: Twelve children who had undergone a Salter or triple pelvic osteotomy fixated with 4.5 mm PLGA screws were included. A total of 18 MRIs was performed 0.5-4.5 years after surgery and were retrospectively analysed. Eight parameters relating to screw resorption, local reactions and re-formation of bone were interpreted. RESULTS: The screw canals were > 90% replaced with solid bone after 2-4.5 years in all cases but one, where the canals were only partly replaced with bone. There were no major soft tissue reactions but small (< 12 mm) bone cysts were observed in 3 of the 18 MRIs and discrete fatty patches in the adjacent bone were common. CONCLUSION: PLGA screws in the paediatric pelvis appear to be resorbed and replaced with solid bone in most cases but this process takes at least 2 years. Minor reactions could be seen in the adjacent bone but were judged to be of no clinical significance.

Using a 3D Printed Model as a Preoperative Tool for Pelvic Triple Osteotomy in Children: Proof of Concept and Evaluation of Geometric Accuracy.

The feasibility of 3D printing in clinical practice depends not only on the usability but also on the reliability of the method. The aims of this study were to demonstrate the feasibility of a 3D printing method for pediatric patients planned for pelvic triple osteotomy and to present a reliable quality assessment strategy for these printed models. A 10-year-old boy with Legg-Calvé-Perthes disease underwent a triple pelvic osteotomy. Preoperative and postoperative CT scans were printed as 3D models. An image-based quality assessment strategy was proposed: The printed 3D models were imaged with CT. The model images were systematically compared with the corresponding ground truth images, ie, patient images, to determine the reliability using distance measurements in the model and ground truth images. The 3D printed models were found useful in both the preoperative and postoperative stages. The models were found reliable: Strong linear correlation between the model and ground truth images both preoperatively (R = 0.99; P < 0.001) and postoperatively (R = 1.00; P < 0.001) was found. The study demonstrates the usefulness of 3D printed models in clinical practice. We also present a robust and simple strategy, using common clinical tools, to assess the reliability of 3D printed models.

Minimal training sufficient to diagnose pediatric wrist fractures with ultrasound.

BACKGROUND: In children, non-fractured wrists generally need no treatment and those that are fractured may only require a 3-week cast without any clinical follow-up. The ability to perform a point-of-care triage decision if radiographs are needed could improve patient flow and decrease unnecessary radiographs. The aim of this study was to evaluate the role of ultrasound (US) as a point-of-care triage tool for pediatric wrist injuries with limited training. METHODS: Physicians with no previous US experience attended a 1.5 h course in the use of US to diagnose distal radius fractures at the Emergency Department (ED). The physicians firstly used US to diagnose a potential fracture and, if the patient had a fracture, grouped the patient according to how they wanted him/her to be treated based on US. The physician then interpreted the subsequent radiographs and decided on a treatment based on this information. Consultant traumatologists and a senior radiologist established a gold standard for correct treatment and radiological diagnosis, respectively. RESULTS: One hundred and sixteen injuries in 115 patients were included. The ED physician identified 75 fractures on radiographs. With the exception of a minimal buckle fracture, all were identified on US. US had a tendency to interpret complete fractures on radiographs as incomplete (n = 7) leading to incorrect treatment decisions. CONCLUSIONS: In the hands of an US novice, US examination is comparable with radiographs as a point-of-care tool to distinguish a fractured wrist from a non-fractured one. US is not, however, as good as radiographs for placing fractured wrists into the correct treatment group. LEVEL OF EVIDENCE: Level III. Diagnostic study of non-consecutive patients.

Ultrasound-assisted triage of ankle trauma can decrease the need for radiographic imaging.

BACKGROUND: An ankle sprain is a common injury, and patients are usually examined with plain radiographs to rule out a fracture despite the fact that only a small minority actually have one. PURPOSE: To investigate if ultrasound (US)-guided triage can decrease the need for radiographic imaging in patients with ankle trauma. HYPOTHESIS: Orthopedic surgeons can use point-of-care US with limited training to triage ankle trauma that requires standard radiographs. METHODS: Seven junior orthopedic surgeons underwent a 30-minute standardized training session using a basic US musculoskeletal examination designed to exclude ankle fractures. One-hundred twenty-two patients with ankle trauma were included at the emergency department and underwent clinical investigation, including examination according to the Ottawa ankle rules as well as US and standard ankle radiographs. In this study group, radiographs identified 23 significant fractures. Ultrasound-guided triage could not exclude a fracture in 37 patients. All of the 23 fractures seen on radiographs were among the 37 patients where US could not rule out a fracture. Ottawa ankle rules managed to exclude the need for radiographs in 28 of the 122 patients, whereas 85 who underwent the US-guided triage could have avoided a radiograph. Avulsion fractures at the tip of the fibula were not considered significant. CONCLUSION: This study demonstrates that with limited standardized training a junior, an orthopedic surgeon is able to use US-guided triage during the primary examination at the emergency department to exclude at least significant ankle fractures. This practice could decrease the need for radiographic imaging, avoiding a mandatory radiographic investigation in many patients with ankle trauma. It would also make it possible to treat many patients with ankle trauma more rapidly and to reduce costs and radiation exposure.

Evasive response to ultrasound by the crepuscular butterfly Manataria maculata.

The crepuscular nymphalid butterfly Manataria maculata was studied in Monteverde cloud forest, Costa Rica, during the dry season reproductive diapause. M. maculata has ears in the form of Vogel's organs located near the base of the forewings. Its behaviour in response to bursts of ultrasonic pulses (26 kHz, 110 dB SPL at 1 m) was condition-dependent. At dusk and dawn the sound consistently elicited evasive responses, similar to those of moths, in flying individuals. In contrast day-roosting individuals always remained motionless although they were alert to other stimuli. The daily movements between day- and night-roosts coincided in time and light intensity with the activity of insectivorous bats. This is the first reported case of ultrasonic hearing connected to evasive flights in a true butterfly (Papilionoidea). It strongly supports the idea that echolocating bats were involved in the evolution of hearing in butterflies.