Search Results (35)

Background/Objectives: Mixed martial arts (MMA) is a popular combat sport combining techniques from various martial arts. The most common injuries in MMA are head, wrist, and hand trauma. However, there is limited research on injuries specifically related to submission techniques prevalent in this discipline. The use of submission techniques, particularly rear-naked chokes and arm locks, may potentially lead to serious injuries. Methods: Submission techniques from 2488 fights from Ultimate Fighting Championship (UFC) were analyzed. Fights from all numbered events between 2000 and 2021 were analyzed, focusing on techniques that lead to fight termination, such as chokes and armbars. Official fight statistics, with additional video verification, were used. The results were statistically analyzed with comparisons between weight categories and sex. Results: Submissions end 18.7% of all MMA fights. The most common submission technique was rear-naked choke, accounting for 68.6% of all submissions. The arm and hand concentrated submission techniques, including the armbar, accounted for 27.1% of all submissions. Female fights were, on average, one and a half minutes longer than male bouts and had significantly fewer submission attempts. Conclusions: MMA fights frequently end by submission, and many submissions involve techniques that put considerable stress on the joints and cervical region. Fighters and referees need clear protocols to swiftly recognize when a submission is causing excessive risk. Full article

Background and Objectives: Distal upper limb injuries are frequent in winter sports, but their functional impact is often underestimated. This study aimed to describe the epidemiology, mechanisms, and risk factors for injuries involving the forearm, wrist, hand, and fingers sustained during two consecutive winter seasons in the Italian Dolomites. Materials and Methods: All adult and willing patients presenting to the Emergency Department of Brixen Hospital after ski- or snowboard-related accidents between December 2023 and March 2025 completed a standardized 23-item questionnaire on demographics, experience level, environmental factors, equipment, and trauma mechanism. For the aim of this study only distal upper limb injuries were extracted and analyzed. Statistical analyses compared fracture versus non-fracture injuries, “good” versus “bad” fractures (AO classification and surgical complexity), and isolated ulnar collateral ligament (UCL) injuries. Results: A total of 195 patients were analyzed: 96 (49.2%) sustained a fracture and 33 (16.9%) presented with isolated UCL lesions. Fractures occurred more frequently on blue slopes (56.2% vs. 33.3%, p < 0.001), whereas non-fracture injuries predominated on red and off-piste slopes. Age, BMI, and skill level did not differ significantly between groups. Surgically classified complex distal forearm fractures were significantly more frequent in females (p < 0.005) but were not associated with environmental factors. UCL injuries occurred mainly on red slopes (54.5%) and were often related to pole entrapment during falls. None of the injured patients reported the use of protective wrist or thumb supports. Conclusions: Distal upper limb injuries are a common pattern of alpine sports trauma, with wrist fractures and skier’s thumb being predominant lesions. Low-speed falls on easy slopes are associated with wrist fractures, while UCL injuries are linked to intermediate slopes. Preventive strategies should include fall technique education, protective gloves, and improved pole ergonomics. Full article

Background and Objectives: Tennis involves repetitive high-velocity movements, rapid directional changes, and challenging environmental conditions, exposing players to injury risk. However, injury surveillance data for North African youth players are lacking. This study aimed to determine the frequency, characteristics, and management of tennis-related injuries among competitive Tunisian youth players. Materials and Methods: A cross-sectional study was conducted among players aged 5–18 years from tennis clubs (October 2023–November 2024). Data were collected using researcher-administered questionnaires, incorporating the Oslo Sports Trauma Research Center Overuse Injury Questionnaire and a sport-specialization assessment, following International Olympic Committee guidelines. Results: Among 256 players, 53.5% (n = 137) reported 366 injuries. Lower limbs were most affected (58.5%), followed by upper limbs (32.8%); knees (23.2%), ankles (17.5%), and wrists (10.1%). Muscle/tendon (36.9%), superficial tissue (28.1%), and ligament/joint capsule injuries (27.6%) predominated. Most injuries occurred during practice (74.9%) and hot weather (93.4%). Severe injuries represented 24%, while 29.5% were minor without time loss. Subsequent injuries occurred in 54.6% of injured players, with significantly higher rates in those with incomplete rehabilitation (p < 0.001). Conclusions: The high frequency of recurrent injuries and limited rehabilitation highlight critical gaps in injury management, emphasizing the need for targeted neuromuscular training, accessible rehabilitation, and standardized return-to-play protocols. Full article

At Stavanger University Hospital (SUH), patients aged 50 years and above with a fracture after a fall are included in our Fracture Liaison Service (FLS) at the orthopaedic department, due to their high imminent fracture risk. The FLS at SUH keeps a quality registry, including index fractures, fall from standing/walking, preventive factors, Dual Absorptiometry X-ray (DXA) results and treatment status, in addition to risk factors such as chronic diseases. As in many other hospitals and countries, the capacity of the DXA scanner at SUH does not meet the needs of the ageing population. As such, FLS patients should be prioritised for DXA scanning according to their need for anti-osteoporotic treatment. The aims of this study were (1) to identify whether any risk factors are more strongly associated with osteoporosis than others, and (2) to use this information as a tool to prioritise patients for which the decision to initiate anti-osteoporotic treatment should be assessed by a DXA scan. Method: We used software from CheckWare to keep a structured health record, submitting journal text to the health record and data to our fracture quality registry from 1 June 2022 to 31 December 2024. The fracture coverage of the registry, as part of the medical record, was 100%. Both men and women aged over 50 years with fragility-related fractures were included in the analysis, with index fracture having been reported within 24 months prior to FLS assessment. Exclusion criteria: short life expectancy (<3 years), already started on anti-osteoporotic treatment, living in nursing home, age >97 years, or multi-trauma patients. Statistics were calculated using SPSS and logistic regression. The results are presented as odds ratio (OR) and 95% confidence interval (95% CI). Significant differences were considered at a p-value of <0.05. Results: A total of 6974 patients were included, 81% of which were female. After the DXA scan, 5307 of the patients were started on anti-osteoporotic treatment (76%). Patients aged 50–70 years were the largest group. Female patients or those aged 80 years or older had an increased odds ratio (OR) of starting treatment after a fracture. The index fractures included in the logistic regression analysis and were most likely to initiate anti-osteoporotic treatment in the FLS, were vertebral fracture (p < 0.000, OR 3.1, 95% CI: 2.4–4.0), hip fracture (p < 0.000, OR 2.60, 95% CI: 1.9–3.5), costa fracture (p-value = 0.028, OR:1.3, 95% CI:1.0–1.5), pelvic fracture (p-value < 0.000, OR 3.1, 95% CI: 1.8–5.1). Patients with lack of sufficient vitamin D had increased odds with OR of 1.7 (p-value < 0.00, 95% CI: 1.3–2.2) for having osteoporosis compared to the other FLS patients. Fall from standing, walking or sitting increased the odds for osteoporosis treatment (p-value < 0.000, OR 2.8, 95% CI: 2.3–3.3). Conclusions: The listed risk factors for needing treatment were high for most fractures, especially vertebral, hip, and pelvic fractures. Patients aged 80+ years and with a fracture from standing/walking could also start treatment directly, without waiting for a DXA scan. Thus, these patients should be shifted rapidly to FLS and started on treatment without delay. In this way, DXA scanning can be prioritised for patients for whom supporting information is needed regarding the decision to initiate anti-osteoporotic treatment, such as those with proximal humerus, wrist, or ankle fractures. Time to DXA scan could be shortened for these patients and 12 weeks may be achievable. Full article

Background and Clinical Significance: Radial nerve palsy typically presents as wrist drop due to nerve compression, with conventional management often yielding prolonged recovery. We report a case where ultrasound-guided hydrodissection (HD) with 5% dextrose in water (D5W) achieved immediate functional restoration, suggesting neurapraxia as the underlying pathology. Case Presentation: A 54-year-old diabetic female presented with acute left wrist drop without trauma. Examination confirmed radial nerve palsy (MRC grade 0 wrist extension), while radiographs ruled out structural causes. Ultrasound revealed fascicular swelling at the spiral groove. Under real-time guidance, 50 mL D5W (no local anesthetic) was injected to hydrodissect the radial nerve. Immediate post-procedure assessment showed restored wrist extension (medical research council (MRC) grade 4+). At one- and three-month follow-ups, the patient maintained complete resolution of symptoms and normal function. Conclusions: This case highlights two key findings: (1) HD with D5W can serve as both a diagnostic tool (confirming reversible neurapraxia through immediate response) and therapeutic intervention, and (2) early HD may circumvent prolonged disability associated with conservative management. The absence of electrodiagnostic studies limits objective severity assessment, though ultrasound localized the lesion. While promising, these observations require validation through controlled trials comparing HD to standard care, particularly in diabetic patients with heightened compression susceptibility. Technical considerations—including optimal injectate volume and the role of adjuvant therapies—warrant further investigation. US-guided HD with D5W emerges as a minimally invasive, surgery-sparing option for acute compressive radial neuropathies, with potential to redefine treatment paradigms when applied at symptom onset. Full article

Low-energy bone fractures refer to injuries that occur from minimal trauma or impact. These fractures are often a result of activities, such as falls from standing height or minor accidents, where the force exerted on the bone is insufficient to cause a break under normal conditions. To design an effective orthotic splint, it is critical to select the appropriate material that mimics the mechanical properties of traditional materials like plaster, which has long been used for immobilization purposes. In this case, Ansys CES Edupack 2025 software was utilized to evaluate and identify materials with mechanical characteristics similar to those of plaster. The software provided a list of six materials that met these criteria, but selecting the most suitable material involved more than just mechanical properties. Three different multicriteria decision-making methods were employed to ensure the best choice: TOPSIS, VIKOR, and COPRAS. These methods were applied to consider various factors, such as strength, flexibility, weight, cost, and ease of manufacturing. The results of the analyses revealed a strong consensus across all three methods. Each approach identified PLA (Polylactic Acid) as the most appropriate material for the orthotic design. Following the material selection process, simulations were conducted to assess the structural performance of the orthotic splint. The results determined that the minimum thickness required for the PLA orthosis was 4 mm, ensuring that it met all necessary criteria for acceptable stresses and deformations during the four primary movements exerted by the wrist. This thickness was sufficient to maintain the orthosis’s functionality without compromising comfort or effectiveness. Moreover, a significant improvement in the design was achieved through topological optimization, where the mass of the preliminary design was reduced by 9.58%, demonstrating an efficient use of material while maintaining structural integrity. Full article

Objectives: The impact of the COVID-19 pandemic on hand surgery in Japan has not been fully elucidated. This study investigated changes in the volume of hand surgery practiced during the pandemic. Methods: We used the National Database Open Data Japan (NDB-ODJ), a comprehensive repository of healthcare data administered by the government, to investigate changes in the volume of hand surgery services delivered during the COVID-19 pandemic. The type and number of upper extremity surgical procedures was examined during each month of the pandemic to identify associations. Results: During the first wave in the spring of 2020, scheduled surgeries decreased by 44% compared to pre-pandemic levels, with arthroplasties, osteotomies, and polydactyly surgeries experiencing the largest reductions. Trauma surgeries remained relatively stable, and some procedures like tendon repair and replantation even increased. While overall surgical volumes recovered in the second half of the pandemic, certain procedures, including finger pinning and tendon repair, remained below pre-pandemic levels. Interestingly, surgeries for Dupuytren contracture and amputation increased compared with the pre-pandemic period. Many scheduled and emergency procedures shifted to outpatient surgeries during the pandemic, and the proportion of inpatient surgeries decreased. In particular, the proportion of outpatient surgeries increased significantly in open reduction and internal fixation for wrist and forearm fractures, as well as in amputation surgeries. Conclusions: The COVID-19 pandemic had a minimal impact on the volume of hand surgery conducted in Japan, with a decrease in elective surgeries only during the first wave in the spring of 2020. Notably, the pandemic triggered a shift from inpatient to outpatient surgery for many procedures. Full article

Physical therapists, because of their care work, are susceptible to work-related musculoskeletal disorders due to their caregiving duties. These disorders have a significant economic and social impact. Objectives: To analyze the prevalence of work-related musculoskeletal disorders among physical therapists and their associated factors. Methods: A cross-sectional design study was conducted among physical therapists who were working in the Community of Madrid. An online questionnaire was used and distributed through the professional association. This questionnaire included sociodemographic and occupational variables as well as the Standardized Nordic Questionnaire, specifically designed for the analysis of musculoskeletal symptoms in an ergonomic or occupational health context. Data were analyzed using multivariate logistic regression models. Results: 212 questionnaires were analyzed. 98.1% reported a musculoskeletal problem in the past 12 months. The most affected regions were the neck (85.4%), upper back (59.4%), lower back (73.1%), shoulder (53.8%), and wrist and hand (63.2%). Neck disorders were associated with women (AOR = 2.41; 95%CI = 1.20–4.82); shoulder disorders with women (AOR = 7.79; 95%CI = 1.02–56.64) and older age (AOR = 1.06; 95%CI = 1.01–1.11); lower back disorders with women (AOR = 3.86; 95%CI = 1.11–13.49), a four-year bachelor’s degree (AOR = 3.56; 95%CI = 1.09–11.62), treating trauma patients (AOR = 0.13; 95%CI = 0.02–0.62), and using manual therapy (AOR = 0.34; 95%CI = 0.15–0.78). Conclusions: 98.1% of the physical therapists reported musculoskeletal symptoms in the past 12 months. Several variables were associated with musculoskeletal disorders: gender, level of education, age, and type of patient and treatment. Further research is needed to identify preventive measures that can reduce the high prevalence of musculoskeletal problems among physical therapists. Full article

Background: Fractures often occur due to equestrian activities with injury patterns varying by age. The purpose of this study was to investigate in detail fracture patterns and associated demographics in children due to equine activities. Materials: The US National Electronic Injury Surveillance System was queried for all injuries with the consumer product code 1239 (horseback riding) from 2000 to 2023. Those <16 years old with fractures were extracted. Statistical analyses were performed with SUDAAN 11.0.01™ software to obtain national estimates. Results: There were an estimated 101,677 patients with a fracture. Girls comprised 72.5% and the patient was discharged from the hospital in 81.5% of cases. Fractures involved the upper extremity in 80,973 (80.0%), the pelvis/lower extremity in 11,794 (11.7%), the spine in 3060 (3.0%), the skull/face in 4321 (4.4%), and the rib/sternum in 940 (0.9%). The humerus, elbow, radius/ulna, and wrist accounted for 62.4% of all the fractures. The youngest age group (0- to 5-year-olds) had more boys and was more likely to be admitted to the hospital. The child was injured due to a fall from the horse in 75.7%, bucked/thrown off/kicked off in 17.0%, with the remaining 7.3% from other mechanisms. Conclusions: This extensive description of fractures in children due to equestrian injuries can be used to determine the effectiveness of future prevention strategies, such as protective equipment and educational programs. It also gives pediatric trauma and orthopedic surgeons an overall view of the types of fractures which occur in children due to equestrian activities. Full article

Large bone defects of the distal radius and/or carpus following tumor resection, trauma, or infection are extremely rare. There are few case reports and series in the literature on the reconstruction approaches required in such cases. Therefore, large studies cannot be used to guide the therapeutic decisions of reconstructive plastic and hand surgeons. The objective of this study is to propose a treatment algorithm to predict the functional outcome and quality of life for the different techniques of free vascularized bone reconstruction in the interval between the distal radius, the carpus, and/or the proximal metacarpal. The algorithm was developed based on our own case studies and the few treatment approaches described in the literature. It can be applied to rare cases of massive bone defects in the wrist. The flowchart enables surgeons to develop an individualized reconstruction concept for various intervals of bone defects in the area of the distal radius and proximal metacarpal bones. Ultimately, the treatment algorithm aims to maximize future quality of life (QoL) and function of the distal upper extremity in rare cases of massive wrist-bone defects. Full article

Radial nerve palsies present a challenging clinical scenario, often leading to substantial functional impairment. This study focuses on evaluating the outcomes of tendon transfer surgeries in patients with post-traumatic radial nerve injuries. The radial nerve, vital for upper limb movements, faces various etiologies, such as trauma, compression, or idiopathy. Patients with radial nerve palsy encounter difficulties in daily activities, emphasizing the need for effective management strategies. The research introduces a novel evaluation protocol, aiming to comprehensively assess tendon transfer outcomes. This protocol incorporates functional movements of wrist and finger joints, encompassing both objective and subjective parameters. The retrospective study includes eleven patients treated between 2010 and 2022, with a minimum follow-up of one year post-surgery. Tendon transfers demonstrated positive results. The evaluation protocol covers a wide range of parameters, including wrist and finger mobility, thumb function, grip strength, and patient satisfaction. The results indicate successful restoration of motor function, with an average grip strength of 70% compared to the healthy arm. The proposed evaluation protocol facilitates standardized and reproducible assessment, minimizing subjective errors in clinical evaluations. Despite the study’s limitations, such as a relatively small sample size, the findings underscore the effectiveness of tendon transfers in treating radial nerve palsies. The introduced evaluation scheme provides a comprehensive and reproducible approach to assess outcomes, contributing to the global standardization of tendon transfer assessments in radial nerve injuries. Full article

Background and Objectives: Non-specific chronic wrist pain is wrist pain that occurs without a specific cause, such as trauma, and may limit the range of motion of the joints of the wrist and hand, affecting muscle strength, grip strength, and function. This study aimed to determine the effects of grip-strengthening exercises combined with wrist stability training on pain and function in patients with non-specific chronic wrist pain. Materials and Methods: The subjects of the study were 31 patients with wrist pain. To determine the effect of grip-strengthening exercises combined with wrist stability training, 15 participants participated in grip-strengthening exercises combined with wrist stability training and 16 control subjects participated. The experimental group participated in wrist-stability training. Grip-strengthening exercises combined with wrist stability training were performed for 20 min/day twice a week for 4 weeks, and relaxation massage and conservative physical therapy were performed for 20 min/day twice a week for 4 weeks. The control group received relaxation massage and conservative physical therapy for 40 min/day twice a week for 4 weeks. A visual pain scale was used to evaluate the degree of pain before and after treatment, and a patient-rated wrist evaluation was used to evaluate wrist function. Results: The results showed that the visual score significantly decreased in the time effect before and after the intervention in both groups (p < 0.001), patient-rated wrist evaluation significantly decreased (p < 0.001), and grip strength and muscle strength significantly increased (p < 0.001). The results of this study showed that grip-strengthening exercises combined with wrist stability training were effective in improving pain, function, grip strength, and muscle strength in patients with non-specific chronic wrist pain. Conclusions: Grip-strengthening exercises combined with wrist stability training can be used as an effective intervention method to improve pain, function, grip strength, and muscle strength, emphasizing the need for wrist exercise interventions in patients with non-specific chronic wrist pain in the future. Full article

Background: The anatomical reconstruction of the wrist is the aim when treating distal radius fractures. Current literature on the importance of preoperative reduction in fractures that are treated operatively is limited. Methods: This study investigated the effect of the preoperative closed reduction of distal radius fractures on the day of trauma and the time to surgery on postoperative palmar inclination. A total of eighty patients (48 females and 32 males, mean age 55.6 years) were studied retrospectively. All patients were treated with an open reduction and internal fixation. The palmar inclination angle was measured using X-rays by two investigators, and the interobservers and pre- and post-reduction parameters were compared. Results: When the surgical management of closed distal radius fractures is required, neither initial repositioning nor a delay of up to 14 days to the surgical treatment influences postoperative palmar inclination. Conclusions: The significance of preoperative reduction of distal radius fractures without neurovascular or extensive soft tissue damage is limited and is not leading to improved outcomes. When surgery is about to be performed, surgeons should carefully consider if reduction is really vital preoperatively. Level of evidence: III. Full article

Bilateral scaphoid fractures are rare lesions, warranting a review to synthesize current knowledge, identify gaps, and suggest research directions. Two authors, adhering to PRISMA guidelines, in January 2024 identified 16 case reports (1976–2023). Data extraction included demographics, injury mechanisms, associated injuries, fracture sites, treatments, and outcomes. Among 121 initial outcomes, 16 articles met the criteria, predominantly affecting young people (93.75% males, mean age 22 years). High-energy traumas (75%) often caused associated wrist injuries (68.75%). Most fractures required surgical intervention (68.75%), primarily headless compression screws. Bilateral scaphoid fractures, which are rare but associated with high-energy traumas, commonly involve wrist injuries. Surgical management is often necessary, yielding better outcomes with fewer complications. Further research is essential to understand the epidemiology, optimal management, and long-term results. Early diagnosis and appropriate treatment are crucial for preventing complications and ensuring favorable patient outcomes. Full article

We present the case of a 14-year-old patient who suffered fracture dislocation of the pisiform bone (PB) along with fractures of the scaphoid, proximal radius, and proximal phalanx of the thumb due to high-energy trauma directly to the extended wrist. This combination of fractures has not been previously reported in the literature. Currently, there is no consensus in the literature regarding the optimal treatment approach for such cases. In our management, initial attempts at closed and open reduction were unsuccessful, leading to the decision for primary pisiformectomy. Our report includes a follow-up of 3.5 years, demonstrating a very good outcome. Based on this case and a few similar published cases, primary pisiformectomy appears to be a viable and well-accepted option, particularly among young patients. Additionally, we conducted a review of radiographic criteria and management strategies for this specific injury and related conditions. Full article