Problem: Pulley-lesions of the fingers are typical injuries in climbing sports. In general, a rupture of the A2-pulley is found, without significant medical impact. Complex pulley-lesions may be devastating for a high-level career in sports climbing. Standard MRI in stretched finger position is not able to evaluate the A3- pulley, which is crucial for graduation of complex pulley lesions. Methods: We introduce stress MRI in a flexed finger position. This allows quantification of the distance between the palmar plate and the deep flexor tendon (A3-distance). Results: According to our data following MRI-examinations of 24 high-level sports climbers an A3-distance of 4 mm or more indicates rupture. An A3- distance up to 1 mm seems to be normal in high-level sports climber. However, due to the small sample number we did not find a clear cut-off point between strain and rupture. Discussion: The rather small and elastic A3-pulley defines the complexity of pulley-lesions. Conservative treatment is preferable if there is still continuity of the A3-pulley. Beside diagnostic imaging, Stress MRI of the fingers give some functional information about an inured A3-pulley in addition. Conclusion: Stress MRI of the fingers is an easy to perform tool for evaluation of the A3-pulley in every MRI-scanner available.

Purpose : To investigate the feasibility and clinical outcomes of individualized bone cement prosthetic replacement in treating advanced lunate bone necrosis. Methods : Nineteen patients (age > 45) diagnosed with advanced lunate bone necrosis underwent the removal of the necrotic lunate bone and replaced with an individualized bone cement prosthetic between January 2010 and December 2020. The visual analogue scale (VAS), range of motion (ROM), grip strength, MMWS (mayo modified wrist score), DASH (disability of arm, shoulder, and hand), carpal height ratio (CHR), ulnar carpal distance ratio (UDR), scaphoid translation ratio (STR), radio scaphoid angle (RSA), and the osteoarthritic were also measured to evaluate the results after at least 1year of follow-up. Results : Nineteen patients were followed up for an average of 63.21 months. At the last visit, the patient’s VAS score was (1.47 ± 0.47) points, and ROM was (130.53 ± 21.34)°, showing improvement compared to preoperative(P < 0.05), although still slightly limited compared to the unaffected side (P < 0.05); the grasp force, MMWS, and DASH scores significantly improved after surgery (P < 0.05), with no further deterioration in wrist joint function compared to postoperative results (P > 0.05). At the last visit, the CHR improved to (0.50 ± 0.06)° and the RSA to (58.8 ± 6.91)° compared to preoperative values (P < 0.05); however, the CHR was still slightly lower than the healthy side (P < 0.05). No significant changes in UDR and STR were observed after surgery (P > 0.05). Additionally, 1 case of bone cement was slightly displaced, and 3 cases showed signs of wrist joint osteoarthritis during the follow-up period. Conclusion : Individualized bone cement prosthetic treatment was effective for advanced lunate bone necrosis in middle-aged and elderly individuals. It helped restore the original anatomical structure, prevent further collapse, and enhance hand function.