Article
Management of Proximal Interphalangeal Joint Repetitive Stress Epiphyseal Fractures in Sport Climbers
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Authors
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Christoph Lutter
- Klinik für Orthopädie und Unfallchirurgie, Klinikum Bamberg, Bamberg, Germany
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Volker Schöffl
- Zentrum für interdisziplinäre Sportmedizin, Klinik für Orthopädie und Unfallchirurgie, Klinikum Bamberg, Bamberg, Germany
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Isabelle Schöffl
- Department of Pediatric Cardiology, University Erlangen-Nuremberg, Erlangen, Germany
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Yasser El-Sheikh
- Department of Surgery, Division of Plastic & Reconstructive Surgery, North York General Hospital, Toronto, Canada
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Sascha Flohé
- Department of Trauma, Orthopedics and Hand Surgery, Klinikum Solingen, Solingen, Germany
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: Repetitive stress fracture of the middle phalanx epiphysis is an injury specific to elite adolescent sport climbers. As sport climbing becomes increasingly popular in younger age groups, an increased number of these injuries have been reported in recent years. To date, treatment of these fractures has been nonsurgical, with strict rest and physiotherapy prescribed until fracture union. However, when these patients present in a delayed fashion with an established nonunion, nonsurgical treatment may fail, leading to disabling chronic pain and/or digital deformity in some cases.
Methods: Adolescent patients with typical complaints after climbing were investigated using a questionnaire to analyze circumstances leading to the injury. After initial ultrasound and radiography, MRI of all fingers with a proven or highly suspected growth plate fractures were performed. CAT scans were performed in prolonged cases with suspected sclerosis of the growth plate exclusively. All 24 patients (n=28 fingers) were then treated conservatively as previously published. In five of these 24 cases, this conservative approach did not cause sufficient healing; therefore a new percutaneous spot drilling epiphysiodesis technique was used to stimulate bony healing.
Results and Conclusions: Of the 28 injured fingers, 95% concerned the middle finger; in 64.3% the crimp grip led to the injury and was the preferred handhold (71.4%). While 75% of the injured adolescents were male, the average age was 14.1 years and all of the adolescent athletes were within the year of their peak velocity growth. Half of the injuries occurred during bouldering competitions. 81% of the injuries were Salter Harris grade 3, only two were grade 1 and 5 respectively. Conservative approach led to full finger function in 19 adolescents, while 5 athletes (n=5 fingers) underwent the surgical procedure. All athletes regained their pre-injury climbing level and had full finger function.
Adolescent climbers are at a high risk for epiphyseal fractures especially during their growth spurt. While most cases show sufficient healing under rest, a surgical procedure is needed in cases refractory to this conservative approach. Percutaneous spot drilling epiphysiodesis is a quick and minimally invasive promising technique that needs to be considered.
