FINGER STRESS FRACTURES IN YOUTH ELITE ROCK CLIMBERS

Abstract

Background: With the inclusion of climbing in the 2020 Olympics, the number of adolescent competitors is on the rise. For the first time in competition history, the 2020 Olympic format requires every climber to compete in a combined format of all three disciplines: bouldering, sport climbing, and speed climbing. For speed climbing specifically, every competitor must compete on the International Federation of Sport Climbing (IFSC) speed wall. Epiphyseal stress fractures to the middle phalanx, also known as growth plate injuries, are almost exclusive to adolescent climbers, and the most common climbing injury in adolescent competitors. A2 pulley ruptures are the most common injury in skeletally mature climbers. There is a paucity of research on youth-specific climbing injuries and no previous research on perceptions of adolescent rock climbers about youth-specific climbing injuries. There is also no previous research that examines the correlation between epiphyseal stress fractures and speed climbing. Purpose: To examine the awareness, perceptions, and training practices of youth-specific climbing injuries and risk factors amongst elite, adolescent rock climbers. Methods: We surveyed elite adolescent rock climbers, ages 8-18, competing in the 2017 USA Climbing Sport and Speed National Championships. Subjects answered questions on their knowledge and awareness of the most common youth climbing injury and safe training practices. Chi Square, one-way ANOVAs, and Bonferroni post hoc tests identified misperceptions about youth climbing injuries and the safe age to start double dyno campusing, a climbing-specific training exercise. Risk ratios were used to make accuracy comparisons between adolescent competitors who self-reported as injury “informed” and “uninformed.” A Fisher’s Exact test was used to determine if training regularly on the IFSC speed wall correlated with self-reported stress fractures. Results: 267 climbers completed the survey (mean age =13.99±2.66 SD, 51.9% male, 48.1% female). The adult-specific A2 pulley injury was erroneously reported by the subjects to be the most common youth climbing injury, with an average ranking of 3.09±2.20 SD 95% confidence interval (CI) on a scale of 1 (most common) to 8 (least common). Growth plate injury to the finger ranked second most common, with an average ranking of 4.0±2.22. These rankings were significantly different (p<0.0001). Only 5.7% of climbers correctly reported the safe age to start double dyno campus board training, a risk factor for growth plate injuries. 48.9% of climbers reported they were aware of growth plate injuries to the finger; yet only 24.5% of these climbers correctly identified the injuries exclusively as stress fractures. 73.5% overall reported growth plate finger injuries to either be a type of A2 pulley injury or did not know. Growth plate injuries were significantly more common among adolescent climbers who trained regularly on the IFSC speed wall (Risk Ratio 1.34 – 13.94, p=0.02). Conclusion: Adolescent climbers are prone to characterizing skeletally immature climbing-specific injuries as A2 pulley injuries seen in skeletally mature climbers. Training regularly on the IFSC speed wall appears to be an additional risk factor for epiphyseal stress fractures. As climbing enters the 2020 Olympics, addressing misperceptions will help athletes, parents, and coaches understand the risk for stress fractures and guide adolescent climbers and parents to seek medical attention when appropriate. Educating youth, coaches, and parents about finger injuries may reduce the incidence of stress fractures and the potential for permanent finger deformity and loss of function. Table 1. Percentage of self-reported injuries by type Self-Reported Injuries by Type Frequency (%) None 41.8% Other 19.9% Ankle Sprain 16.1% Pulley Injury 14.9% Back/Posture Pain 13.4% Tendon Injury to Wrist 10.9% Elbow Tendonitis 10.0% Rotator Cuff/Labrum injury of shoulder 9.2% Growth plate injury to finger 4.6% Meniscus tear of knee 1.1% Figure 1. Average response ranking when asked to rank most common youth climbing injury between GPI informed and GPI uninformed (Error bars = 95% Cl, p<0.0001). Table 2. Percent and 95% Cl of athlete responses for all athletes, GPI uninformed, and GPI informed. All Athletes GPI Uninformed GPI Informed Percent 95% Cl Percent 95% Cl Percent 95% Cl Fig. 1 A2 pulley most common 35.5% (29.1, 42.2) 41.3% (31.8, 51.4) 30.2% (22.0, 39.4) Fig. 1 GPI most common 15.0% (10.6, 20.4) 6.7% (2.7, 13.4) 22.4% (.152, .311) Fig. 2 Identified GPI as a stress fracture 31.3% (25.3, 37.7) 12.4% (7.1, 19.6) 52.8% (42.9, 62.6) Fig. 2 Identified GPI exclusively as a stress fracture 14.5% (10.2, 19.8) 5.8% (2.4, 11.6) 24.5% (16.7, 33.8) Fig. 3 Correctly identified safe double dyno age 5.7% (3.2, 9.4) 4.0% (.56. 7.44) 7.5% (2.8, 12.2) Figure 2. Percent of all athlete responses for question “growth plate injuries to the finger are a…” (Error bars = 95% Cl, p<0.0001). Figure 3. Response percentages for question “safe age to start double dyno campusing” between GPI informed and GPI uninformed (Error bars = 95% Cl, p=.2381). For all athletes not split, p<0.0001. According to the British Mountain Council, the safe age is 18+.