Kirschner Wire Fixation in Dorsally Displaced Distal Radius Fractures: A Biomechanical Evaluation.

Background There is currently no consensus for the optimum configuration and number of Kirschner wires (K-wires) to use for the stabilization of dorsally displaced distal radius fractures. In this biomechanical study, we compared the load to failure and stiffness of four common K-wire configurations to identify the strongest construct for use in extra-articular dorsally displaced distal radius fractures. Case Description We created a standard distal radius fracture model in turkey tarsometatarsi which was stabilized using two or three K-wires (1.6 mm) in four different configurations. Following a power calculation, 10 fracture models of each configuration underwent testing in cantilever bending and axial compression. Literature Review Recent randomized trials have shown no evidence that volar locking plates are superior to K-wires for the treatment of dorsally displaced distal radius fractures. This has led to an increase in the popularity of much cheaper K-wires. Several different K-wire techniques have been described but there is no strong evidence to determine which is the optimal configuration and number of wires. Clinical Relevance The three-wire interfragmentary configuration was stiffer than the three-wire Kapandji in axial compression and cantilever bending. There was no difference in load to failure in cantilever bending or axial compression. The three-wire interfragmentary technique is the stiffest configuration of K-wires for dorsally displaced distal radius fractures. The two-wire Kapandji technique was significantly weaker than the other configurations, especially in cantilever bending. Conclusion The authors recommend to always use three wires for percutaneous pinning and never to use two intrafocal wires alone.

Passive range of motion of the hips and shoulders and their relationship with ball spin rate in elite finger spin bowlers.

OBJECTIVES: Investigate rotational passive range of motion of the hips and shoulders for elite finger spin bowlers and their relationship with spin rate. DESIGN: Correlational. METHODS: Spin rates and twelve rotational range of motion measurements for the hips and shoulders were collected for sixteen elite male finger spin bowlers. Side to side differences in the rotational range of motion measurements were assessed using paired t-tests. Stepwise linear regression and Pearson product moment correlations were used to identify which range of motion measurements were linked to spin rate. RESULTS: Side to side differences were found with more external rotation (p = 0.039) and less internal rotation (p = 0.089) in the bowling shoulder, and more internal rotation in the front hip (p = 0.041). Total arc of rotation of the front hip was found to be the best predictor of spin rate (r = 0.552, p = 0.027), explaining 26% of the observed variance. Internal rotation of the rear hip (r = 0.466, p = 0.059) and the bowling shoulder (r = 0.476, p = 0.063) were also associated with spin rate. CONCLUSIONS: The technique and performance of elite finger spin bowlers may be limited by the passive range of motion of their hips and shoulders. The observed side to side differences may indicate that due to the repetitive nature of finger spin bowling adaptive changes in the rotational range of motion of the hip and shoulder occur.

When research leads to learning, but not action in high performance sport.

Research from sports science and related clinical and scientific fields produces knowledge that is often highly relevant to high performance sport. However, there exists a gap between current science and applied coaching or sports science practice. Addressing, and bridging, this gap from both sides of the research-application divide is an important ambition. In this commentary we discuss the wonderful, yet often unforgiving challenge of improving athlete performance as a practitioner or coach in high performance sport. Blending existing knowledge (that which we know works), transferable knowledge (that which has worked elsewhere), anecdotal observations (that which we have seen work) and innovation (where the risk: reward ratio of it working at all is high), to find the right solution, at the right time, for the specific (and often unique) individual is the challenging "art" of application. Here we explore this challenge related to the high performance sports system and the people within it, then more specifically to coaching and learning, and finally to practitioners and athletes using a case study example of applying sleep science to the high performance environment.