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Atesok K.,Musculoskeletal Research Laboratory | Doral M.N.,Hacettepe University | Whipple T.,Orthopaedic Research of Virginia | Mann G.,Meir Medical Center | And 6 more authors.
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2011

Purpose: The purpose of this article was to systematically analyze the results of published studies in the literature which evaluated the use of arthroscopically assisted techniques in intra-articular fracture fixation. Methods: Published investigations to date were analyzed by classifying them according to joints that were involved with intra-articular fractures including: knee, ankle, hip, shoulder, elbow, and wrist joints. The results were studied to assess the feasibility, efficiency, and outcomes of arthroscopy-assisted fracture fixation. Results: Arthroscopy-assisted techniques have been used successfully for the treatment of fractures of the tibial plateau, tibial eminence, malleoli, pilon, calcaneus, femoral head, glenoid, greater tuberosity, distal clavicle, radial head, coronoid, distal radius, and scaphoid. The major advantages of arthroscopic fracture fixation over open methods are direct visualization of the intra-articular space, decreased invasiveness, and the possibility for multitask interventions through which fixation of the fracture, and repair of the soft tissues and the cartilage can be performed simultaneously. The time-consuming and technically demanding nature of the procedures with a prolonged learning curve and limited fixation alternatives are the main disadvantages of this technique. Conclusion: Arthroscopic fixation is increasingly utilized for certain intra-articular fracture types due to the minimally invasive nature of the procedures and high accuracy. Randomized controlled trials are needed to justify wider use of arthroscopy-assisted techniques for treatment of intra-articular fractures. © 2010 Springer-Verlag.

Milgrom C.,Hebrew University of Jerusalem | Burr D.B.,Indiana University | Finestone A.S.,Assaf feh Medical Center | Voloshin A.,Lehigh University
Bone | Year: 2015

Previous human in vivo tibial strain measurements from surface strain gauges during vigorous activities were found to be below the threshold value of repetitive cyclical loading at 2500 microstrain in tension necessary to reduce the fatigue life of bone, based on ex vivo studies. Therefore it has been hypothesized that an intermediate bone remodeling response might play a role in the development of tibial stress fractures. In young adults tibial stress fractures are usually oblique, suggesting that they are the result of failure under shear strain. Strains were measured using surface mounted unstacked 45° rosette strain gauges on the posterior aspect of the flat medial cortex just below the tibial midshaft, in a 48. year old male subject while performing vertical jumps, staircase jumps and running up and down stadium stairs. Shear strains approaching 5000 microstrain were recorded during stair jumping and vertical standing jumps. Shear strains above 1250 microstrain were recorded during runs up and down stadium steps. Based on predictions from ex vivo studies, stair and vertical jumping tibial shear strain in the test subject was high enough to potentially produce tibial stress fracture subsequent to repetitive cyclic loading without necessarily requiring an intermediate remodeling response to microdamage. © 2015 Elsevier Inc.

Moran D.S.,Heller Institute of Medical Research | Moran D.S.,Ariel University | Evans R.,U.S. Army | Arbel Y.,Heller Institute of Medical Research | And 5 more authors.
Scandinavian Journal of Medicine and Science in Sports | Year: 2013

This study aimed to measure ambulation in infantry army basic training, and to evaluate if covering more distance can explain stress fractures in a stressor-stress model. Forty-four male combat recruits (18.7±0.7 years) participated in a 6-month rigorous high intensity combat training program. Baseline data included anthropometric measurements, VO2max, and psychological questionnaires. Actual distance covered was measured using a pedometer over an 11-week training period. Psychological questionnaires were repeated after 2 months. Sixteen recruits were diagnosed with stress fractures by imaging (SFi=36.4%). Statistical analysis included comparing measured variables between SFi and those without stress fractures (NSF). The recruits covered 796±157km, twofold the distance planned of 378km (P<0.001). The SFi group covered a distance 16.4% greater than that of the NSF group (866±136 and 744±161km, respectively, P<0.01), and also demonstrated greater psychological stress. These data reveal the importance of adherence to or enforcement of military training programs. In the light of these data, the Israeli Defense Forces program needs reappraisal. A stressor-stress response might explain the susceptibility of certain recruits for injury. Using advanced technology, monitoring ambulation may prevent stress fracture development by limiting subjects exceeding a certain level. Psychological profile may also play a role in predicting stress fracture development. © 2011 John Wiley & Sons A/S.

Bar-Dayan Y.,Israel Defense Force Medical Corps | Bar-Dayan Y.,Wolfson Medical Center | Morad Y.,Israel Defense Force Medical Corps | Elishkevitz K.P.,Israel Defense Force Medical Corps | And 3 more authors.
Spine Journal | Year: 2012

Background context: Back problems are reported with increasing frequency in adults and adolescents. Most information is from self-reported questionnaires or studies with small sample sizes. Reports were usually focused on specific diseases and biased toward overdiagnosis. Purpose: To assess the prevalence of common back disorders among a large cohort of 17-year-old males and females recruited by the Israel Defense Forces (IDF). Study design: A retrospective cross-sectional prevalence study. Patient sample: Seventeen-year-old Israeli male and female military recruits reporting as directed by the IDF for preinduction medical examination between January 01, 1998 and December 31, 2006. Outcome measures: Military functional limitation Grades 1 to 7 per diagnosis category. Methods: Military recruits were examined and classified based on medical and orthopedic diagnoses. They were referred for orthopedic consultation as necessary. Four orthopedic classifications were used: spinal deformity (including kyphosis and scoliosis), back pain (including neck and radicular syndromes), spondylolysis/olisthesis, and limitations resulting from trauma or spinal surgery. Data were coded into a central database, and descriptive statistics are presented. Results: The overall prevalence of back disorders among 828,171 17-year-old military recruits (61.5% male) was 16.8%. Back disorders resulting in significant functional limitation were diagnosed in 0.8% of recruits. The most prevalent diagnoses were spinal deformities (kyphosis and scoliosis, females 11.9%, males 11.5%) and back pain (females 3.0%, males 5.6%). Most of these diagnoses were rated as mild. Conclusions: When using objective criteria, overall back disorders in a large population of 17-year-old recruits were 17%, considerably lower than most reports. Back morbidity severe enough to prevent combat duty occurred at a rate of less than 1%, suggesting that serious back morbidity is not a frequent finding in this age group. Level of evidence: Symptom prevalence study, Level III. © 2012 Elsevier Inc. All rights reserved.

Constantini N.,Hebrew University of Jerusalem | Finestone A.S.,Assaf feh Medical Center | Hod N.,Israel Defense Forces | Hod N.,Tel Aviv University | And 6 more authors.
Military Medicine | Year: 2010

Purpose: The study was planned to assess whether combat equipment weight reduction would lead to a reduction in the incidence of stress fractures in female border police infantry recruits taking a 4-month course of basic combat training. Method: 213 female border police recruits, 18-19 years of age, undergoing 16 weeks of basic combat training with lighter rifl e and lighter closely fi tted combat vest, (total 9.4 kg) were followed prospectively for stress fracture (SFx) incidence, compared to a historical control group of 1,210 recruits who trained with traditional equipment (12.5 kg). Results: Equipment modifi cation was associated with a signifi cant reduction in SFx from 18.3% in the control group to 8.0% in the intervention group ( p < 0.0001). Conclusions: This study implies that equipment weight reduction may achieve a signifi cant effect in SFx reduction. Approximating fi ghting gear to body center of gravity may enhance this effect. Copyright © 2010 Association of Military Surgeons of the US. All rights reserved.

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