Lower Limb Region Research Articles

Running Consistency Affects Odds Of Injury In Several Lower Limb Regions

Running Consistency Affects Odds Of Injury In Several Lower Limb Regions

Histopathological Pattern and Audit of Skin Tumors Seen in Nnamdi Azikiwe University Teaching Hospital, Nnewi, South-East Nigeria: A 10-year Retrospective Study

Abstract Background: Skin tumors consist of neoplastic lesions that affect the integumentary system which includes skin, hair, nails, and related muscles and glands. Diagnosis of these lesions can be a dilemma for both physicians and pathologists. Tumors of the skin are more heterogeneous than those of any other organ in the body, and this is a result of varying types of cells which can give rise to both benign and malignant skin lesions. Aim and Objectives: The aim of this is to audit the histopathological patterns of skin tumors seen in Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, South-East Nigeria. Materials and Methods: All cases of skin tumors diagnosed in the center within the study period of January 2013 to December 2022 were retrieved from the archives of the Anatomic Pathology Laboratory, NAUTH. Histology slides of the cases that met the inclusion criteria were carefully reviewed. Then, tissue blocks for those diagnosed as malignant skin tumors, were sent for immunohistochemistry. The data obtained were analyzed using the Statistical Package for the Social Sciences version 20.0. Results: There were a total of 206 cases that met the inclusion criteria, 103 males (50.0%) and 103 females (50.0%). The most common tumor as seen in the study is squamous cell carcinoma (SCC) (19%), with the least common being cylindroma, sebaceoma, and trichoepithelioma (1% each). The peak age incidence is in the third decade. The anatomic site most affected by the tumors is the head-and-neck region (78%) followed by the lower-limb region (66%) and the least affected is the anogenital region (25%). Immunohistochemistry showed a 100% correlation for the malignant skin tumors. Conclusion: The overall most common skin tumor is SCC followed by hemangioma, whereas trichoepithelioma, sebaceoma, and cylindroma are the least common. The most common benign tumor is hemangioma, whereas the least common benign tumors are trichoepithelioma and cylindroma. The most common and least common malignant tumors are SCC and Paget’s disease respectively. This study served to generate baseline data for the histopathologic pattern of both benign and malignant skin tumors in NAUTH, Nnewi.

The Percentage of Total and Regional Fat Is Negatively Correlated with Performance in Judo.

This study investigated the associations between total and regional body composition with performance in the special judo fitness test (SJFT), as well as strength and power tests (countermovement vertical jump-CMJ, squat jump-SJ, plyometric push-up-PPU, and force push-up-FPU). Twenty-three high-level judo athletes participated in this study. Initially, they underwent dual-energy X-ray absorptiometry, after which they performed the CMJ, SJ, PPU, and FPU tests. On another day, the SJFT was carried out. Correlations were tested using Pearson's test. The performance in the SJFT was correlated with the total and arm %fat mass (r = -0.759), torso fat mass (r = -0.802), torso %fat mass (r = -0.822) and in the lower limb regions with the leg fat mass (r = -0.803) and leg %fat (r = -0.745). In the strength and power tests, there were also negative correlations observed between regional fat and performance. There was a negative correlation between the percentage of total fat and performance in the SJFT (r = -0.824), SJ (r = -0.750), CMJ (r = -0.742), PPU (r = -0.609), and FPU (r = -0.736). Fat, both total fat and regional fat in the arms, torso, and legs, is strongly correlated with a poor performance in the SJFT and poor strength and power.

Perceived Effectiveness of Cadaveric and Three-dimensional Virtual Dissection in Learning Anatomy among First-Year MBBS Students: A Cross-sectional Study from Northeastern India

Abstract Introduction: The advent of three-dimensional (3D) virtual digital technology in the 21st century has tremendously impacted medical education worldwide. The aim of the present study is to evaluate the attitude and response of first-year MBBS students toward traditional cadaveric dissection and 3D virtual dissection in learning human anatomy through descriptive validated questionnaires. Methodology: The present study is a cross-sectional and observational study. Fifty students of first-year MBBS batch of a tertiary medical college in north-east region of India were taught gross anatomy of the human body by cadaveric, 3D virtual, and combined dissection methodologies in the Department of Anatomy, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Mawdiangdiang, Shillong, Meghalaya, India, over a period of 1 year. The students assessed the perceived effectiveness of different dissection methodologies through semi-structured questionnaires at the first-phase, mid-phase, and at the end-phase of the study. Results More than half of the respondents (60%) preferred learning the gross anatomy of the upper limb and lower limb regions by “combined 3D virtual followed by cadaveric dissection methodology.” At the completion of thorax and abdomen regions, 28 students (56%) voted for “combined cadaveric followed by 3D virtual dissection methodology.” At the completion of the study, all students preferred the combined dissection methodology with 30 (60%) students preferring the “combined cadaveric followed by 3D virtual dissection methodology” while 26 (52%) students voted for the “combined 3D virtual followed by cadaveric dissection methodology.” The feedback from the validated questionnaires at the completion of the study was statistically analyzed using Cronbach’s alpha test. Conclusions: The findings suggest that both the combined dissection methodologies complemented each other very well in understanding, recalling, and learning human anatomy, with the highest rating coming from both the combined dissection methodologies.

Amyotrophic lateral sclerosis regional progression intervals change according to time of involvement of different body regions.

The prediction of disease course is one of the main targets of amyotrophic lateral sclerosis (ALS) research, particularly considering its wide phenotypic heterogeneity. Despite many attempts to classify patients into prognostic categories according to the different spreading patterns at diagnosis, a precise regional progression rate and the time of involvement of each region has yet to be clarified. The aim of our study was to evaluate the functional decline in different body regions according to their time of involvement during disease course. In a population-based dataset of ALS patients, we analysed the functional decline in different body regions according to time and order of regional involvement. We calculated the regional progression intervals (RPIs) between initial involvement and severe functional impairment using the ALS Functional Rating Scale revised (ALSFRS-r) subscores for the bulbar, upper limb, lower limb and respiratory/thoracic regions. Time-to-event analyses, adjusted for age, sex, ALSFRS-r pre-slope (ΔALSFRS-R), cognitive status, and mutational status were performed. The duration of RPI differed significantly among ALS phenotypes, with the RPI of the first region involved being significantly longer than the RPIs of regions involved later. Cox proportional hazard models showed that in fact a longertime between disease onset and initial regional involvement was related to a reduced duration of the RPI duration in each different body region (bulbar region: hazard ratio [HR] 1.11, 95% confidence interval [CI] 1.06-1.16, p < 0.001; upper limb region: HR 1.16, 95% CI 1.06-1.28, p=0.002; lower limb region: HR 1.11, 95% CI 1.03-1.19, p=0.009; respiratory/thoracic region: HR 1.10, 95% CI 1.06-1.14, p=0.005). We found that the progression of functional decline accelerates in regions involved later during disease course. Our findings can be useful in patient management and prognosis prediction.

Diagnostic utility of susceptibility-weighted imaging in amyotrophic lateral sclerosis

Susceptibility-weighted imaging (SWI) was developed as a diagnostic tool for amyotrophic lateral sclerosis (ALS). However, its sensitivity and specificity are insufficient for accurate diagnosis. Herein, we investigated a new, simple evaluation method for SWI as a diagnostic marker for ALS. We retrospectively investigated 36 patients with ALS and 19 healthy controls. The low signal intensity was semi-quantitatively evaluated on SWI using the motor cortex low intensity (MCLI) score: the sum score of the visual evaluation for the signal intensity of the bilateral primary motor cortices (orofacial, upper-limb, and lower-limb regions) from 0 (isointense) to 2 (markedly hypointense) with a total of 12 points. The mean MCLI score of two independent raters was significantly higher in ALS (median [interquartile range]; 5 [4–6]) than in controls (0 [0–1]), p < 0.0001. When the cutoff value of the MCLI score was set to 3, the area under the receiver operating characteristic curve was 0.973, and the sensitivity and specificity were 0.92 and 1.00, respectively. The MCLI score was not significantly correlated with age, disease duration, and ALS functional rating scale-revised (FRS-R), but was significantly correlated with the progression rate (∆FRS) (ρ = 0.39, p = 0.021) and upper motor neuron score (ρ = 0.51, p = 0.0014). Therefore, MCLI scoring is a useful diagnostic marker for ALS as the MCLI score was correlated with the UMN and ∆FRS scores.

Use of Microscope-Integrated Near-Infrared Fluorescence for Enhancing Deep Lymphatic Vessel Detection during Supermicrosurgical Lymphaticovenous Anastomosis: A Longitudinal Cohort Study.

The default setting of microscope-integrated near-infrared fluorescence (MINIRF) using indocyanine green for locating superficial lymphatic vessels during lymphaticovenous anastomosis was limited to less than or equal to 70 percent intensity. The authors investigated whether maximizing the MINIRF intensity setting could increase the number of deep lymphatic vessels being found, thereby increasing the total number of lymphatic vessels for lymphaticovenous anastomosis. This longitudinal cohort study enrolled 94 patients (86 female and eight male patients) with lower limb lymphedema. Superficial lymphatic vessels were identified with the MINIRF default setting, before maximal intensity was used for deep lymphatic vessel detection. Primary/secondary endpoints included the number of superficial and deep lymphatic vessels identified. No control was used. Demographic data, intraoperative findings [including superficial and deep (indocyanine green-enhanced and non-indocyanine green-enhanced) lymphatic vessels], and severity of lymphosclerosis were recorded. Data in three regions of the lower limb (i.e., foot/above ankle, below knee, and thigh) were compared. A total of 481 lymphatic vessels were identified, comprising 260 superficial and 221 deep lymphatic vessels. The median number of lymphatic vessels found per patient was five (interquartile range, four to six), and the median lymphatic vessel size was 0.63 mm (interquartile range, 0.5 to 0.8 mm). No difference was found in number (p = 0.360), size (p = 0.215), or severity of lymphosclerosis (p = 0.226) between the overall superficial and deep lymphatic vessels in the three lower limb regions. Deep lymphatic vessel detection can be aided by maximizing MINIRF intensity. These deep lymphatic vessels are comparable to superficial lymphatic vessels in number, size, and functionality, making them potentially valuable for lymphedema improvement. Diagnostic, II.

اپیدمیولوژی آسیب های اسکلتی - عضلانی اندام فوقانی و اندام تحتانی در بین کشتی گیران کاراد تالوکا

Introduction: Wrestling has been a very ancient and popular sport in India. A variety of biomechanical forces are applied on these athletes due to the very nature of this game, leading to injury to different parts of the body. This study aimed to find the prevalence of musculoskeletal injuries among wrestlers from the taluka of Karad. Methods: 100 wrestlers were selected for this study based on the inclusion and exclusion criteria. They completed a structured questionnaire to assess for any injuries regarding wrestling and also their demographic data was recorded. Results: All the wrestlers reported at least 1 lesion. The most commonly injured body regions were at the lower limb region (57.1%) and then at upper limb region (31.4%). Lesions were more frequent in the Lower limb region (45%) and less in the Upper limb region (13%). Sprains were commonly seen in the Lower limb region (34%) as well and followed by Upper limb region (28%). Conclusion: musculoskeletal injuries of both the upper and lower extremities was found to be high among the wrestlers of Karad. It was found to be more common in males and less in females. Lesions and sprains were found to be more frequent in the lower limb region of the body.

Analysis of firearm deaths from Central Delhi region-A 6-year retrospective study

Firearm injuries were well known for their atypical findings and appearances in routine so a retrospective study from 2013 to 2018 was performed to evaluate the morphology of firearm injuries and the damaged caused by it. Data of 65 cases was collected from post mortem notes of the deceased. It was observed that the age group of 21–40 years was most commonly affected with 63 cases (96.9%) and a male: female ratio 31.5: 1. Individuals of the Hinduism religion (50 cases, 76.9%) were most commonly affected and most of the victims were brought dead or were dead on the spot (34 cases, 52.3%). Rifled firearm weapon most commonly used (63 cases, 96.9%) while shotgun was used in 02 cases (3.1%). Single entry (43 cases, 66.2%) and exit wounds 37 cases (56.9%) were most commonly observed. In 41 cases (63.1%) no bullet was recovered while single bullet was recovered in 16 cases (24.6%) during post mortem examination. Entry wounds were most commonly found on head, face and neck region of body in 29 cases (44.6%) followed by chest region in 26 cases (40.0%), while right lower limb region with one case (1.5%) was least commonly found. Exit wounds were most commonly found on head, face and neck region (22 cases, 33.8%) followed by back region (15 cases, 23.1%). Lungs (22 cases, 33.8%) and brain (21 cases, 32.3%) were most commonly damaged organs in firearm injuries while kidneys and spleen (2 cases, 3.1%) each were least commonly involved organs. Skull and facial bones (23 cases, 35.4%) were most commonly fractured bones by firearm weapons followed by ribs and clavicle (17 cases, 26.2%). Abrasion collar was the most common entry wound artefact (53 cases, 81.5%) followed by smudging/blackening/stippling (20 cases, 30.8%). Homicidal was the most common manner of death with 44 cases (67.7%), followed by Suicidal with 15 cases (23.1%). Shock and Haemorrhage was the most common cause of death with 30 cases (46.2%).

Gait biometrics: investigating the use of the lower inner regions for people identification from landmark frames

The recent technological advances in surveillance, forensic and biometric systems to deter or even reduce the increasing number of crimes and prevent them is still questionable. The use of gait biometrics has attracted unprecedented interest due to its capability to work with low-resolution footage recorded from a distance. In contrast to mainstream research on gait biometrics which uses holistic silhouette features, the authors investigate the use of the bottom dynamic section within the human body to derive the most discriminative features for gait recognition. A new descriptor based on 7 Hu's moments is proposed describing the inner lower limb regions between the limbs being extracted only from landmark frames within one gait cycle. In order to assess the discriminatory potency of gait features from the lower regions for people identification, a number of experiments are conducted on the CASIA-B gait database to investigate the recognition rates using the KNN classifier and deep learning. The comparative analysis is performed against well-established research studies which were tested on the CASIA-B data set. The obtained results confirm the consistency of features extracted from the lower regions for gait recognition even under the impact of various factors.

Evaluation of biokinetics and dosimetry in [131I]-NaI therapies: whole-body images quantification versus lower limb region

Evaluation of biokinetics and dosimetry in [131I]-NaI therapies: whole-body images quantification versus lower limb region

Analysis of clinical application patterns in acupuncture-moxibustion treatment of Alzheimer disease

To summarize the clinical application patterns in acupuncture-moxibustion treatment of AD by reviewing the clinical literatures on acupuncture-moxibustion for Alzheimer disease (AD) published between January 2009 and December 2019. China National Knowledge Infrastructure (CNKI), Wanfang Academic Journal Full-text Database (Wanfang), Chongqing VIP Database (CQVIP), Chinese Medicine Acupuncture-moxibustion Information Database, PubMed Medical Data Retrieval Service System, Springer Database and Ovid Technologies (OVID) were retrieved to screen clinical studies of acupuncture-moxibustion treatment of AD according to the inclusion and exclusion criteria to conduct quantitative, clustering and association analyses. In acupuncture-moxibustion treatment of AD, the frequently used points were Baihui (GV 20), Zusanli (ST 36), Sishencong (EX-HN 1), Taixi (KI 3), Sanyinjiao (SP 6), and Neiguan (PC 6) in the descending order. Regarding meridians, the most frequently used one was the Governor Vessel, followed by the Stomach Meridian of Foot Yangming and Gallbladder Meridian of Foot Shaoyang. From the perspective of body regions, the points in the head-face region and the lower-limb region had the highest frequencies, followed by the upper-limb, back and chest-abdomen regions. The point group, Baihui (GV 20) and Sishencong (EX-HN 1)-Neiguan (PC 6)-Sanyinjiao (SP 6), showed the most significant association, and the group winning the second place was Baihui (GV 20) and Sishencong (EX-HN 1)-Neiguan (PC 6)-Zusanli (ST 36). The clustering analysis showed that the commonly used point pairs included Zusanli (ST 36)-Sishencong (EX-HN 1) and Taixi (KI 3)-Sanyinjiao (SP 6), which were closely associated with Baihui (GV 20). By analyzing the three commonly used acupuncture-moxibustion methods, acupuncture plus medication was found achieving the best result in the total effective rate and mini-mental state examination (MMSE) score, followed by monotherapy of electroacupuncture therapy, and these two methods were superior to acupuncture alone (P<0.05); the scores of MMSE, Alzheimer disease assessment scale-cognitive section (ADAS-cog) and activity of daily living scale (ADL) showed significant improvements after treatment (all P<0.01). In the acupuncture-moxibustion prescriptions for AD, the main points are Baihui (GV 20), Sishencong (EX-HN 1), Neiguan (PC 6), Zusanli (ST 36), Sanyinjiao (SP 6) and Taixi (KI 3). Monotherapy of acupuncture has the highest frequency amongst the treatment methods, but its effective rate is lower than that of acupuncture plus medication and monotherapy of electroacupuncture.

A systematic review and meta-analysis of bone loss in space travelers

Bone loss in space travelers is a major challenge for long-duration space exploration. To quantify microgravity-induced bone loss in humans, we performed a meta-analysis of studies systematically identified from searching Medline, Embase, Web of Science, BIOSIS, NASA Technical reports, and HathiTrust, with the last update in November 2019. From 25 articles selected to minimize the overlap between reported populations, we extracted post-flight bone density values for 148 individuals, and in-flight and post-flight biochemical bone marker values for 124 individuals. A percentage difference in bone density relative to pre-flight was positive in the skull, +2.2% [95% confidence interval: +1.1, +3.3]; neutral in the thorax/upper limbs, −0.7% [−1.3, −0.2]; and negative in the lumbar spine/pelvis, −6.2 [−6.7, −5.6], and lower limbs, −5.4% [−6.0, −4.9]. In the lower limb region, the rate of bone loss was −0.8% [−1.1, −0.5] per month. Bone resorption markers increased hyperbolically with a time to half-max of 11 days [9, 13] and plateaued at 113% [108, 117] above pre-flight levels. Bone formation markers remained unchanged during the first 30 days and increased thereafter at 7% [5, 10] per month. Upon landing, resorption markers decreased to pre-flight levels at an exponential rate that was faster after longer flights, while formation markers increased linearly at 84% [39, 129] per month for 3–5 months post-flight. Microgravity-induced bone changes depend on the skeletal-site position relative to the gravitational vector. Post-flight recovery depends on spaceflight duration and is limited to a short post-flight period during which bone formation exceeds resorption.

Fat distribution may predict intra- or extra-capsular hip fracture in geriatric patients after falling

IntroductionHip fractures can be divided into intra-capsular and extra-capsular fracture based on fracture location; these two types of fracture have different pathogeneses, treatments and prognoses. Many factors influence the patterns of hip fractures, including the injury mechanism, areal bone mineral density and the geometry of the hip. However, the relationship between body composition and hip fracture pattern has not yet been discussed.In this investigation, an analysis of the body compositions of geriatric patients with hip fractures were conducted to identify differences between fat and muscle distributions between patients with intra- and extra-capsular hip fractures. Material and methodsFrom December 2017 to February 2019, 139 patients with a hip fracture were prospectively enrolled in this study. The groups of patients that were diagnosed as having intra- and extra-capsular hip fractures were compared in terms of patient demographics, pre-operative laboratory data, bone mineral density (BMD) and body composition including muscle and fat distributions obtained using dual-energy X-ray absorptiometry (DXA) . ResultsEighty-six and 53 patients were diagnosed with intra-capsular and extra-capsular hip fractures, respectively. A significantly higher serum glucose level, a lower hemoglobin level, a lower T-score level in the proximal femur region, a lower T-score of all parts of interest, and a lower percentage fat content on the region of bilateral proximal hips (gynoid region) and in the lower limb region, were observed in patients with an extra-capsular hip fracture than in those with an intra-capsular hip fracture. However, with all confounding factors controlled for, only the T-score at the proximal femur, percentage fat content in the region of bilateral proximal hips and the ratio of android fat content to gynoid fat content (A/G ratio) are the most relevant factors in predicting the patterns of hip fracture in geriatric patients after falling. ConclusionThis work demonstrates that lower fat content in the region of bilateral proximal hips and a lower BMD on the proximal femur may predict greater vulnerability of geriatric patients to extra-capsular rather than intra-capsular hip fracture after a falling accident.

Somatotopic organization of the human spinothalamic tract: in vivo computed tomography-guided mapping in awake patients undergoing cordotomy.

The location of the human spinothalamic tract (STT) in the anterolateral spinal cord has been known for more than a century. The exact nature of the neuronal fiber lamination within the STT, however, remains controversial. After correlating in vivo macrostimulation-induced pain/temperature sensation during percutaneous cervical cordotomy with simultaneous CT imaging of the electrode tip location, the authors present a modern description of the somatotopy of the human cervical STT. Twenty patients underwent CT-guided percutaneous cervical cordotomy to alleviate contralateral medication-refractory cancer pain. Patient responses to electrical stimulation (0.01-0.1 V, 50 Hz, 1 msec) were recorded and the electrode location for each response was documented with a contemporaneous CT scan. In a post hoc analysis of the data, the location for each patient's response(s) was measured and drawn on a diagram of their cord. Positive responses were represented only when the lowest possible voltage (≤ 0.02 V) elicited a response. Negative responses were recorded if there was no clinical response at 0.1 V. Clinically, patients did well with an average reduction in opiates of 75% at 1 week, and 67% were able to leave the palliative care unit. The size of the cervical cord varied between patients, with an average lateral extent (width) of 11 mm and a height of 9 mm. Responses from the lower limb were represented superficially (lateral) and posteriorly within the anterolateral cord. The area with responses from the upper limb was larger and surrounded those with responses from the lower limb primarily anteriorly and medially, but also posteriorly. In this study, the somatotopic organization of the human STT was elucidated for the first time using in vivo macrostimulation and contemporaneous CT imaging during cordotomy. In this cohort of patients, the STT from the lower-limb region was located superficially and posteriorly in the anterolateral quadrant of the cervical cord, with the STT from the upper-limb region surrounding it primarily anteriorly and medially (deep) but also posteriorly. The authors discuss how the previous methods of cordotomy may have biased the earlier versions of STT lamination. They suggest that an ideal spinal cord entry site for cordotomy of either the upper- or lower-limb pain fibers is halfway between the equator and anterior pole of the cord.

New Viewpoint of Surface Anatomy Using the Curved Sectional Planes of a Male Cadaver.

BackgroundThe curved sectional planes of the human body can provide a new approach of surface anatomy that the classical horizontal, coronal, and sagittal planes cannot do. The purpose of this study was to verify whether the curved sectional planes contribute to the morphological comprehension of anatomical structures.MethodsBy stacking the sectioned images of a male cadaver, a volume model of the right half body was produced (voxel size 1 mm). The sectioned images with the segmentation data were also used to build another volume model. The volume models were peeled and rotated to be screen captured. The captured images were loaded on user-friendly browsing software that had been made in the laboratory.ResultsThe browsing software was downloadable from the authors' homepage (anatomy.co.kr). On the software, the volume model was peeled at 1 mm thicknesses and rotated at 30 degrees. Since the volume models were made from the cadaveric images, actual colors of the structures were displayed in high resolution. Thanks to the segmentation data, the structures on the volume model could be automatically annotated. Using the software, the sternocleidomastoid muscle and the internal jugular vein in the neck region, the cubital fossa in the upper limb region, and the femoral triangle in the lower limb region were observed to be described.ConclusionFor the students learning various medical procedures, the software presents the needed graphic information of the human body. The curved sectional planes are expected to be a tool for disciplinary convergence of the sectional anatomy and surface anatomy.

Surprising origin of two carved bones donated to the Buchenwald Memorial Museum

Unidentified bones were donated to the Buchenwald Memorial Museum in Weimar, Germany. The donor thought the bones may have belonged to internees of the concentration camp and had been decoratively carved by camp personnel. Non-destructive forensic anthropological examination was carried out on the bones to identify their possible origin. Comparative human and non-human bones samples were used to determine the provenance of the bones and the anatomical region they may have come from. Literature and internet searches were conducted to trace the origin of the carved motifs on the bones. The bones were determined to belong to the lower limb region of bovids. The carvings were found to correspond with those of existing bone examples found in some museums in the UK. They were traced to German prisoners of war dating to the First World War. An in-depth examination of the donated bones revealed their non-human provenance. It further showed that no link existed between the bones, internees of the concentration camp, and the time of the camp's existence. It was discovered that they belonged to the period 1914-1918 and form an important part of German prisoner of war history in the UK.

Overuse Injuries in the IDF's Combat Training Units: Rates, Types, and Mechanisms of Injury.

Overuse injuries are responsible for most lost training days and attrition from combat training in the Israeli Defense Forces (IDF) as in armies around the world. The purpose of this study is to understand the rates, types, and mechanism of occurrence of overuse injuries in the IDF in order to provide the IDF's commanders a detailed updated situation report in order to enable commanders decision-making, prevention policy, and further research of this highly significant military public health issue. A cross-sectional study including 20,000 soldiers recruited to combat units during the year of 2013 was performed. Most of the data were collected from the IDF's computerized medical consultation records package. Descriptive statistics (percent, mean, standard deviation, and median) were used in order to express results. The study was approved by the IDF's institutional review board. The overall injury rate was 24.5%. The total number of injuries was 6,393 with an average of 1.32 ± 0.22 injuries per injured soldier. The injury rate was 18.4% in the infantry units and 36.1% in non-infantry units. Of all injuries, 87% occurred in the lower back and lower limb regions. The most frequent injury sites were the calf and ankle (34%), the knee region (22%), and the lower back (19%). Of all injuries, 74% occurred during running (45%) or long-distance walking (29%). The average lost training days due to injuries was 9 d per soldier and 6.5 d per injury. The total number of stress fractures was 494-2.5% of all soldiers (four fractures per 100 person years). The calf and ankle region was the most frequent site of stress fractures and accounted for 84% of all stress fractures, the vast majority of them (95%) were fractures of the distal tibia. The average number of lost training days due to stress fractures was 16 ± 6.1 per fracture. As in other armies around the world, overuse injuries in the IDF are a major public health problem and poses a significant challenge to the IDF's commanders and the medical corps policy leaders. Further studies should be performed in order to identify the risk factors for these injuries especially in the lower back and the lower limb regions as part of the effort to try and reduce the rates of these injuries as much as possible. This study emphasizes the need for a continuous surveillance and monitoring system for overuse injuries as a significant and integral component of any intervention plan in the domain of overuse injuries.

Incidence of Overuse Musculoskeletal Injuries in Military Service Members With Traumatic Lower Limb Amputation

ObjectiveTo describe the incidence of overuse musculoskeletal injuries in service members with combat-related lower limb amputation. DesignRetrospective cohort study. SettingMilitary treatment facilities. ParticipantsService members with deployment-related lower limb injury (N=791): 496 with a major lower limb amputation and 295 with a mild lower limb injury. InterventionsNot applicable. Main Outcome MeasuresThe outcomes of interest were clinical diagnosis codes (International Classification of Diseases–9th Revision) associated with musculoskeletal overuse injuries of the lumbar spine, upper limb, and lower limb regions 1 year before and 1 year after injury. ResultsThe overall incidence of developing at least 1 musculoskeletal overuse injury within the first year after lower limb amputation was between 59% and 68%. Service members with unilateral lower limb amputation were almost twice as likely to develop an overuse lower or upper limb injury than those with mild combat-related injury. Additionally, service members with bilateral lower limb amputation were more than twice as likely to develop a lumbar spine injury and 4 times more likely to develop an upper limb overuse injury within the first year after amputation than those with mild combat-related injury. ConclusionsIncidence of secondary overuse musculoskeletal injury is elevated in service members with lower limb amputation and warrants focused research efforts toward developing preventive interventions.

Lower Limb Metaphyseal Bone Is Lost in Men with Coeliac Disease and Does Not Relate to Parathyroid Status.

Aims. To investigate regional lower limb bone density and associations with weight, PTH, and bone breakdown in coeliac men. Methods. From whole body DXA scans bone mineral density (BMD) was measured in 28 coeliac men, in the lower limb (subdivided into 6 regions, 3 being metaphyseal (mainly trabecular) and 2 diaphyseal (mainly cortical)). BMD at femoral neck (FN) and lumbar spine L2–4, body weight, height, serum calcium, alkaline phosphatase, parathyroid hormone (PTH), and urinary calcium and NTx/Cr, a measure of bone breakdown, were also measured. Age matched healthy men provided values for BMD calculation of z and T scores and for biochemical measurements. Results. Low BMD z scores were found at metaphyseal regions in the leg (p < 0.001) and in the FN (p < 0.05). The distal metaphyseal region BMD in the leg was lower than spine or FN (p < 0.05). PTH, urinary calcium/creatinine, and urinary NTx/Cr were similar to controls. Both metaphyseal and diaphyseal BMD z scores were associated with body weight (p < 0.02), but not with either PTH or urinary NTx/Cr. Conclusions. Low BMD lower limb regions comprising mostly trabecular bone occur early in CD and in the absence of elevated PTH or increased bone resorption. Low BMD is associated with low body weight.