At long-term follow-up many first-time male traumatic shoulder dislocators remain symptomatic.

Objectives: To assess the status at 13 to 17 years follow-up of a cohort of young male traumatic shoulder dislocators.

Study Design: Prospective cohort study.

Methods: A prospective study of first-time young male traumatic shoulder dislocators, began in 2004.

Significance of tibial MRI findings of special forces recruits at the onset of their training.

Introduction: MRI is commonly used to evaluate medial tibial stress syndrome (MTSS), based on grading assessments developed in civilian populations. When MTSS represents stress fracture, rest is required to allow for bone remodelling to occur. False positive evaluations can lead to unnecessary recruit attrition.

strains at the middle and distal thirds of the tibia during exertional activities.

There is a known variance in the incidence and anatomical site of tibial stress fractures among infantry recruits and athletes who train according to established uniform training programs. To better understand the biomechanical basis for this variance, we conducted axial strain measurements using instrumented bone staples affixed in the medial cortex, aligned along the long axis of the tibia at the level of the mid and distal third of the bone in four male subjects. Strain measurements were made during treadmill walking, treadmill running, drop jumps from a 45 cm height onto a force plate and serial vertical jumps on a force plate.

Utility of preinduction tests as predictors of attrition in infantry recruits: a prospective study.

Introduction: Infantry recruit attrition wastes resources and can affect combat readiness. The purpose of this study was to examine the utility of preinduction tests as a predictor of attrition among conscripts in the first year of infantry training.

Methods: 303 infantry conscripted recruits participated in a prospective study.

Medial tibial stress fracture diagnosis and treatment guidelines.

Objectives: To validate and make evidence based changes to the Israel Defense Forces medial tibial stress fracture diagnosis and treatment protocol.

Design: Prospective cohort study.

Methods: 429 Elite infantry recruits were reviewed for signs and symptoms of medial tibial stress fracture during 14 weeks of basic training.

Differences in the principal strain angles during activities performed on natural hilly terrain versus engineered surfaces.

Background: Tibial stress fractures in military recruits occur beginning with the fourth week of training. In and ex vivo tibial strain experiments indicate that the repetitive mechanical loading during this time may not alone be sufficient to cause stress fracture. This has led to the hypothesis that the development of tibial stress fracture is mediated by the bone remodeling response to high repetitive strains.

Pathological fracture risk assessment in patients with femoral metastases using CT-based finite element methods. A retrospective clinical study.

Physician recommendation for prophylactic surgical fixation of a femur with metastatic bone disease (MBD) is usually based on Mirels' criteria and clinical experience, both of which suffer from poor specificity. This may result in a significant number of these health compromised patients undergoing unnecessary surgery. CT-based finite element analyses (CTFEA) have been shown to accurately predict strength in femurs with metastatic tumors in an ex-vivo study.

Should Patients With Frozen Shoulder Be Screened for Diabetes Mellitus?

Background: Idiopathic frozen shoulder (nontraumatic) is commonly encountered in patients between the ages of 35 and 60 years in general orthopaedic practice. While the prevalence of frozen shoulder among the general population is estimated to be between 2% and 4%, a significantly higher prevalence of 10% to 22% has been reported in patients with diabetes mellitus. Since diabetic patients are more prone to develop frozen shoulder than nondiabetics, the question arises as to whether patients diagnosed as having idiopathic frozen shoulder are at greater risk to develop diabetes mellitus and should be routinely screened for this condition.

The effect of stress fracture interventions in a single elite infantry training unit (1983-2015).

Stress fractures can be seen as an undesired byproduct of demanding physical training. The threshold value of stress that places an individual bone at high risk for stress fracture has not been identified. In a prospective study of stress fractures in 1983, a 31% incidence was found during demanding Israeli infantry basic training by bone scan criteria.

The search for the best infantry boot.

Background: The combat role of the twenty-first century infantry soldier has changed and accordingly their boots should evolve to meet these new needs and maximize soldier performance.

Objective: To evaluate injuries and durability of the hot weather infantry boots (HWIB) in elite infantry training and assess the initial performance of newly designed Israeli infantry boots (NDIB).

Methods: In Phase 1, the durability of the HWIB during elite infantry training was evaluated at weeks 10, 19 and 64 in a cohort of 67 recruits.

Understanding the etiology of the posteromedial tibial stress fracture.

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.

Participation in ball sports may represent a prehabilitation strategy to prevent future stress fractures and promote bone health in young athletes.

Sports participation has many benefits for the young athlete, including improved bone health. However, a subset of athletes may attain suboptimal bone health and be at increased risk for stress fractures. This risk is greater for female than for male athletes.

The supine apprehension test helps predict the risk of recurrent instability after a first-time anterior shoulder dislocation.

Background: We previously identified the positive result of the supine apprehension test after completion of rehabilitation following a first dislocation as a possible predictor of high risk for redislocation. We extend the follow-up of a previous cohort of patients with first-time shoulder dislocations to better assess this test.

Methods: Fifty-three men aged 17 to 27 years who sustained a first traumatic shoulder dislocation were treated by shoulder immobilization for 4 weeks and then rehabilitated with a standard physical therapy protocol.

Predicting the stiffness and strength of human femurs with real metastatic tumors.

Background: Predicting patient specific risk of fracture in femurs with metastatic tumors and the need for surgical intervention are of major clinical importance. Recent patient-specific high-order finite element methods (p-FEMs) based on CT-scans demonstrated accurate results for healthy femurs, so that their application to metastatic affected femurs is considered herein.

Methods: Radiographs of fresh frozen proximal femur specimens from donors that died of cancer were examined, and seven pairs with metastatic tumor were identified.

Evaluation of the performance of females as light infantry soldiers.

A few countries permit women to serve in combat roles, but their long term performance in these positions has not been reported. The incidences of overuse injuries and attrition of 85 male and 235 female recruits in a light infantry brigade was followed in a three-year prospective study. Females were shorter (162 cm, CI 161-163 cm) than males (174 cm, CI 173-176), had more body fat (18.

Achilles tendons hypertrophy in response to high loading training.

Background: Whether the human Achilles tendon undergoes hypertrophic changes as measured by an increase in cross-sectional area, in response to endurance training exercise remains in question. We investigated the hypothesis that transition from civilian life through 6 months of elite infantry training would induce adaptive Achilles tendon hypertrophy.

Methods: Seventy-two new elite infantry recruits had the cross-sectional area of their Achilles tendons measured at a point 2.

The case for orthopaedic medicine in Israel.

Background: Musculoskeletal complaints are probably the most frequent reasons for visiting a doctor. They comprise more than a quarter of the complaints to primary practitioners and are also the most common reason for referral to secondary or tertiary medicine. The clinicians most frequently consulted on musculoskeletal problems, and probably perceived to know most on the topic are orthopaedic surgeons.

Patient-specific FE analyses of metatarsal bones with inhomogeneous isotropic material properties.

The mechanical response of human metatarsal bones is of importance in both research and clinical practice, especially when associated with the correction of Hallux Valgus. Verified and validated patient-specific finite-element analysis (FEA) based on CT scans developed for human femurs are extended here to the first and second metatarsal bones. Two fresh-frozen metatarsal #1 and five metatarsal #2 bones from three donors were loaded in-vitro at three different angles.

The effect of very high versus very low sustained loading on the lower back and knees in middle life.

To evaluate the effect of the extremes of long term high and low physical activities on musculoskeletal heath in middle age, a historical cohort study was performed. The MRI knee and back findings of 25 randomly selected subjects who were inducted into the armed forces in 1983 and served at least 3 years as elite infantry soldiers were compared 25 years later, with 20 randomly selected subjects who were deferred from army service for full time religious studies at the same time. Both cohorts were from the same common genome.

Pattern of outsole shoe heel wear in infantry recruits.

Background: Excessive shoe heel abrasion is of concern to patients, parents and shoe manufacturers, but little scientific information is available. The purpose of this study was to describe the phenomenon in a group of infantry recruits performing similar physical activity, and search for biomechanical factors that might be related.

Methods: Seventy-six subjects (median age 19) enrolled.

Toward verified and validated FE simulations of a femur with a cemented hip prosthesis.

Background: Verified and validated CT-based high-order finite element (FE) methods were developed that predict accurately the mechanical response of patient-specific intact femurs. Here we extend these capabilities to human femurs undergoing a total hip replacement using cemented prostheses.

Methods: A fresh-frozen human femur was CT-scanned and thereafter in vitro loaded in a stance position until fracture at the neck.