gms | German Medical Science

Objectives/Interrogation: Epiphyseal stress fracture of the base of the middle phalanx is the most common injury among adolescent sport climbers and observed only in this sport. The purpose of this study was to evaluate subject characteristics, injury mechanism and clinical outcome.

Methods: All adolescent sport climbers with pain at the dorsal base of the middle phalanx with or without fractures (Salter-Harris Typ III) who were treated at our department between 2006 and 2018 were included in the study. A questionnaire was sent to all patients about their specific climbing and training habits. In climbers were the questionnaire was not sent back, the patient chart records were used only. All patients were treated conservatively with reduction of load and regular clinical and radiological control (either to document consolidation or to detect a late development of a fracture) every 2-3 months until pain disappeared.

Results and Conclusions: 28 climbers (21 male) with 67 affected fingers could be evaluated. 16 patients completed the questionnaire addressing injury details as well as training behavior before and after the injury. The mean age at the time of injury was 14.0 years (±1.4 years). Middle (58%) and ring (30%) finger PIP joint were found to be the most common sites of injury. All suffered from pain at the dorsal base of the middle phalanx while 16 patients had a fracture in 22 fingers, two of them developed the fracture only at a follow up control. Mean time for consolidation was 8 months (2-24 months). One patient who presented late showed a destruction of the epiphysis with severe joint surface incongruence and signs of osteoarthritis. 9 patients showed mild joint surface incongruence. 37.5% had only slight pain occasionally during climbing and 75% climbed still regularly at the same level or better as before. Nearly half of the patients (43.7%) included campus board exercises and one fourth of the patients (25%) trained specifically on small holds.

Epiphyseal fatigue fracture of the base of the proximal phalanx is a unique injury in adolescent sport climbers which can lead to severe damage of the growth plate with a joint surface incongruence when left untreated resulting in permanent impairment of the affected finger. Dorsal finger pain at the PIP joint in adolescent climbers must be assessed carefully and consultation of an experienced physician should be considered at an early stage and patients should be followed until the pain disappears, which may take several months.