Examinando por Autor "Blasi, Marc"

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    Ítem
    High-resolution ultrasound tendon-to-bone distances in partial and complete finger flexor A2 pulley ruptures simulated in human cadaver dissection: toward understanding imaging of partial pulley ruptures
    (Frontiers Media S.A., 2023-06-07) Iruretagoiena Urbieta, Seber; Schöffl, Volker; Balius Matas, Ramón; Blasi, Marc; Dávila, Fernando ; Sala Blanch, Xavier; Sancho Amundarain, Igor ; Fuente Ortiz de Zárate, J. de la
    Introduction: The A2 pulley tear is the most common injury in rock climbing. Whereas complete A2 pulley ruptures have been extensively researched, studies focused on partial A2 pulley ruptures are lacking. A2 pulleys rupture distally to proximally. High-resolution ultrasound imaging is considered the gold-standard tool for diagnosis and the most relevant ultrasound measurement is the tendon-to-bone distance (TBD), which increases when the pulley ruptures. The purpose of this study was to establish tendon-to-bone distance values for different sizes of partial A2 pulley ruptures and compare these values with those of complete ruptures. Material and methods: The sample consisted of 30 in vitro fingers randomly assigned to 5 groups: G1, no simulated tear (control); G2, simulated 5 mm tear (low-grade partial rupture); G3, simulated 10 mm tear (medium-grade partial rupture); G4, simulated 15 mm tear (high-grade partial rupture); and G5, simulated 20 mm or equivalent tear (complete rupture). A highly experienced sonographer blinded to the randomization process and dissections examined all fingers. Results: The tendon-to-bone distance measurements (medians and interquartile ranges) were as follows: G1, 0.95 mm (0.77–1.33); G2, 2.11 mm (1.78–2.33); G3, 2.28 mm (1.95–2.42); G4, 3.06 mm (2.79–3.28); and G5, 3.66 mm (3.55–4.76). Significant differences were found between non-torn pulleys and simulated partial and complete pulley ruptures. Discussion: In contrast, and inconsistent with other findings, no significant differences were found among the different partial rupture groups. In conclusion, the longer the partial pulley rupture, the higher the tendon-to-bone distance value. The literature is inconsistent regarding the tendon-to-bone distance threshold to diagnose a partial A2 pulley rupture. The minimum tendon-to-bone distance value for a partial rupture was 1.6 mm, and tendon-to-bone distance values above 3 mm suggest a high-grade partial pulley rupture (15 mm incision) or a complete pulley rupture.
  • Miniatura
    Ítem
    Reliability and validity of ultrasound in identifying anatomical landmarks for diagnosing A2 pulley ruptures: a cadaveric study
    (Multidisciplinary Digital Publishing Institute (MDPI), 2024-10) Iruretagoiena Urbieta, Seber; Schöffl, Volker; Balius Matas, Ramón; Blasi, Marc; Dávila, Fernando; Sala Blanch, Xavier; Dorronsoro, Asier; Fuente, Javier de la
    Background/Objectives: Rock climbing is becoming more popular, leading to an increased focus on diagnosing and treating related injuries. Finger pulley and flexor tendon injuries are common among climbers, with the A2 pulley being the most frequently affected. High-resolution ultrasound (US) is the preferred method for detecting pulley injuries. This study aimed to determine the reliability and validity of US in identifying anatomical landmarks for diagnosing A2 pulley ruptures. Methods: This study was cross-sectional, involving 36 fingers from 4 cadaver arms. A Canon Aplio i800 US machine was used to measure two anatomical landmarks: the midpoint of the proximal phalanx and the distal edge of the A2 pulley. For the first anatomical landmark, the length of the proximal phalanx (PP distance), and for the second landmark, the distance between the distal edges of the proximal phalanx and the A2 pulley (“A” distance), were measured. Measurements were performed by two sonographers and compared to a digital caliper measurement taken post-cadaver dissection. Observers were blinded during measurements to ensure unbiased results. Results: Overall PP distance measured by US (O1: 37.5 ± 5.3 mm, O2: 37.8 ± 5.4 mm) tended to be shorter than caliper measurements (O3: 39.5 ± 5.5 mm). The differences between sonographers were minimal, but larger when compared to caliper measurements. High reliability for PP distance measurement was observed, especially between sonographers, with an ICC average of 0.99 (0.98, 1.00). However, reliability was lower for the “A” distance, with significant differences between US and caliper measurements. Regarding validity, US measurements were valid when compared to caliper measurements for PP distance, but not as reliable for the “A” due to wider confidence intervals. While US can substitute caliper measurements for PP distance (LR, Y:O2, X:O3, −0.70 (−3.28–1.38), 0.98 (0.93 ± 1.04)), its validity for “A” distance is lower (LR, Y:O2, X:O3, −2.37 (−13.53–4.83), 1.02 (0.62–1.75)). Conclusions: US is a reliable and valid tool in identifying anatomical landmarks for diagnosing A2 pulley ruptures, particularly for detecting the midpoint of the proximal phalanx. This is important to differentiate between complete and partial A2 pulley tears. However, the measurement of the “A” distance requires further refinement. These findings support efforts to standardize US examination protocols and promote consensus in diagnostic methodology, though further research is needed to address the remaining challenges.