The sequelae of high mechanical stress to the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints of the fingers in elite sport climbers and its contribution to the development of osteoarthritis are still relatively unknown. The purpose of this study was to investigate the evolution of cartilage abnormalities of the PIP and DIP joints, as well as the progress of osteophytes, in the fingers of elite sport climbers with a minimum of 25 years of climbing history over the time period of the last 10 years. Moreover, their actual cartilage abnormalities and osteophyte occurrence were compared to non-climbing age-matched controls. Thirty-one elite male sport climbers and 15 male non-climbers underwent a sonographic examination of the PIP and DIP joint cartilage and osteophyte thickness in the frontal and sagittal plane of digits II-V of both hands. The same cohort had already been measured with an identical protocol 10 years earlier (follow-up rate of 100%). Compared to the baseline assessment 10 years earlier, the cartilage thickness of sport climbers has significantly decreased; however, it was still greater than in age-matched controls. Moreover, sport climbers showed significantly higher relative frequencies of osteophyte occurrence than non-climbers (all fingers and joints). Nevertheless, despite a substantial (and compared to baseline a further increased) occurrence of osteophytes in elite sport climbers, there was no association between the radiological signs of osteoarthritis and pain within the last six months prior the follow-up investigation. KEYWORDSAthletes; overuse; hand; finger joint; osteoarthritis; climbing Highlights. Long-term elite climbers show thicker cartilage and occurrence of Osteophytes in their fingers (especially Digit III) compared to controls already early in their career. . Later occurrence of osteophytes increases (especially Digit II and IV) and cartilage decreases but is still thicker compared to controls. No association between those findings and pain was found.

Proximal femur fractures represent a major healthcare problem in the aging society. High rates of post-operative infections are linked to risk factors that seem to affect local microcirculation. Patterns and time courses of alterations in microcirculation have, however, not been previously investigated. The aim of this prospective cohort study was to evaluate perioperative changes in microcirculation after trochanteric femur fractures using non-invasive laser-Doppler spectrophotometry to analyze how oxygen saturation (SO 2 ), hemoglobin content (Hb) and blood flow changed before and after surgery, and how these parameters were altered by implant type, gender, smoking, diabetes and age. Measurements were separately recorded for nine locations around the greater trochanter in 2, 8, and 15 mm depths, before surgery and 8, 24, 48 h, 4, 7, and 12 days after surgery in 48 patients. Three implants were compared: Dynamic Hip Screw, Gamma3 Nail, and Percutaneous Compression Plate. Surgery resulted in significant differences between the healthy and injured leg in SO 2 , Hb and flow. Each parameter showed comparable values for both legs prior to surgery. Significantly higher values in SO 2 and flow were registered in women compared to men before and after surgery. Smoking caused significant increases in SO 2 , Hb, and flow only in the superficial layer of the skin after surgery. Diabetes decreased blood flow at 2 and 8 mm depth and increased SO 2 at 8 and 15 mm depth after surgery. Age revealed a significant negative correlation with flow. The ability to increase the flow rate after surgery decreased with age. Comparison of implants indicated the minimally invasive implant PCCP altered microcirculation less than the DHS or the Gamma3 nail. Overall, the proximal femur fracture alone did not alter local skin microcirculation significantly in a way comparable to the effect caused by surgery. In conclusion, microcirculation after proximal femur fractures is highly affected by surgery, gender, smoking, diabetes, age and implant in ways specified in this study.

Background and Objectives: Three-dimensional planning and guided osteotomy utilizing patient-specific instrumentation (PSI) with the contralateral side used as a reference have been proven as effective in the treatment of malunions following complex fractures of the distal radius. However, this approach has not yet been described in relation to fracture reduction of the distal radius. The aim of this study was to assess the technical and logistical feasibility of computer-assisted surgery in a clinical setting using PSI for fracture reduction and fixation. Materials and Methods: Five patients with varied fracture patterns of the distal radius underwent operative treatment with using PSI. The first applied PSI guide allowed specific and accurate placement of Kirschner wires inside the multiple fragments, with subsequent concurrent reduction using a second guide. Results: Planning, printing of the guides, and operations were performed within 5.6 days on average (range of 1–10 days). All patients could be treated within a reasonable period of time, demonstrating good outcomes, and were able to return to work after a follow-up of three months. Mean wrist movements (°) were 58 (standard deviation (SD) 21) in flexion, 62 (SD 15) in extension, 73 (SD 4) in pronation and 74 (SD 10) in supination at a minimum follow-up of 6 months. Conclusions: Three-dimensional planned osteosynthesis using PSI for treatment of distal radius fractures is feasible and facilitates reduction of multiple fracture fragments. However, higher costs must be taken into consideration for this treatment.