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Biomedical subjects

C Milgrom

Publications and source records attributed to C Milgrom.

At least 55 records · Page 3Linked to original sources
PubMed1989

The area moment of inertia of the tibia: a risk factor for stress fractures.

In a prospective study of stress fractures among Israeli infantry recruits, the area moment of inertia of the tibia was found to have a statistically significant correlation with the incidence of tibial, femoral and total stress fractures. Recruits with "low" area moments of inertia of the tibia were found to have higher stress fracture morbidity than those with "high" area moments of inertia. The best correlation was obtained when the area moment of inertia was calculated about the AP axis of bending at a cross-sectional level corresponding to the narrowest tibial width on lateral X-rays, a point which is at the distal quarter of the tibia. This finding indicates that bending forces about the approximate AP axis are an important causal factor for tibial and many other stress fractures. The bone's bending strength, or ability to resist bending moments, as measured by the area moment of inertia, helps determine risk to stress fracture.

Biomechanical Phenomena↗
PubMed1989

Marcher's digitalgia paresthetica among recruits.

In a prospective study of 30 male Israeli military recruits a 47% incidence of digitalgia paresthetica was found. The mean time of onset of symptoms was in the fourth week of training. The numbness was bilateral in 11 of 14 of the cases and the mean number of toes involved was 4.5. The first toe was the most commonly involved (11 of 14 patients). No correlation between shoe type (either 3/4 running shoes or standard military boots) was found. At 9-month follow-up, 7 of 9 affected recruits reviewed were asymptomatic. This finding suggests that marcher's digitalgia paresthetica is a neuropraxia. In this study, it developed during the early phases of march training when recruits are adapting to marching with heavy pack and rifle.

Humans↗
PubMed1989

Combined effect of foot arch structure and an orthotic device on stress fractures.

In a prospective study, quantitative measures of the structure of the longitudinal arch of the foot were established and related to the incidence of stress fractures in the bones of the lower limbs of military recruits. In addition, the role of a semirigid orthotic device (Langer military stress orthotic) in preventing stress fractures was evaluated as a function of the structure of the longitudinal arch. Femoral and tibial stress fractures were found to be more prevalent in the presence of feet with high arches, whereas the incidence of metatarsal fractures was higher in feet with low arches. The use of an orthotic device reduced the incidence of femoral stress fractures only in the presence of feet with high arches and the incidence of metatarsal fractures only among feet with low arches. The findings suggest that the normal foot with a low arch acts as a better shock absorber than the normal foot with a high arch, and that an orthotic device may improve the shock absorbing capacity of the arch.

Adult↗
PubMed1989

The Israeli elite infantry recruit: a model for understanding the biomechanics of stress fractures.

In a series of prospective studies among infantry recruits the biomechanics of stress fractures have been studied. In this recruit model bone geometry and the natural shock absorbers of the body have been found to be related to stress fracture morbidity. Using the technique of accelerometry in this model, it has been shown that in the fatigue state shock absorption decreases, resulting in an increase in the amplitude of vertical accelerations that propagate up the skeleton at heel strike. Experiments to study the possibility of lowering stress fracture morbidity in this model by means of viscoelastic orthotics have been successful only in the case of femoral and metatarsal stress fractures among certain subpopulations. Stress fracture management in this model has been improved by early detection and by treatment regimens according to a protocol that emphasizes limited rest periods to allow healing to take place rather than judging recovery by pain levels.

Biomechanical Phenomena↗
PubMed1989

Stress fractures of the sacrum following strenuous activity.

Three military recruits developed stress fractures in the sacral wing during rigorous elite basic training. Stress fractures in the sacrum have previously not been reported in a healthy population. Sacrum, like every bone of the pelvis and the lower limb that participates in weight bearing, may be susceptible to stress fracture following sustained excessive physical activity.

Adolescent↗
PubMed1989

The effect of pretraining sports activity on the incidence of stress fractures among military recruits. A prospective study.

In a prospective study of stress fractures among Israeli infantry recruits, no correlation was found between the recruits' prior participation in sports activities or their aerobic physical fitness and the incidence of stress fractures during basic training. This finding discredits the concept that improving physical fitness prior to basic training can be a prophylactic means of limiting the incidence of stress fractures during subsequent training.

Adult↗
PubMed1988

Bone scintigraphic findings in recruits after short periods of nonweight-bearing ambulation. A report of two cases.

Two military recruits with suspected stress fractures underwent scintigraphy after brief periods of nonweight-bearing ambulation. Their scans showed a dramatic, diffuse increase of activity over the asymptomatic weight-bearing foot, with areas of increased focal activity. Our reported cases illustrate how gait changes can be reflected in scintigraphy and the difficulty in evaluating areas of increased focal scintigraphic activity in the feet. The physician should see the bone scan and not rely on a written report when evaluating a trainee for possible stress fracture.

Achilles Tendon↗
PubMed1988

An analysis of the biomechanical mechanism of tibial stress fractures among Israeli infantry recruits. A prospective study.

The biomechanical mechanism of tibial diaphyseal stress fractures was studied prospectively in a group of 286 Israeli recruits. Before training each recruit had roentgenograms taken of his tibiae. Measurements of total tibial and cortical widths in the anteroposterior (AP) and mediolateral planes were made on these roentgenograms at two levels: at the point of the narrowest tibial width on AP roentgenograms (Level 1) and at the point of the narrowest width on lateral roentgenograms (Level 2). The tibial cross section was idealized as an eccentric ellipse within an ellipse, and on the basis of measurements taken from the roentgenograms, the cross-sectional area (compression strength), area moments of inertia about AP and mediolateral axes of bending (bending strength), and the area polar moment of inertia (torsional strength) were calculated for each cross section. During the course of 14 weeks of training, 20% of the recruits sustained tibial diaphyseal stress fractures, all of which were along the medial cortex. Using stepwise logistic regression analysis the tibia's bending strength along an AP axis of bedding at Level 2 was found to be the most significant factor determining whether or not a recruit would develop a tibial stress fracture.

Adult↗
PubMed1987

Stress fractures and tibial bone width. A risk factor.

A prospective study of 295 infantry recruits has shown that the mediolateral width of the tibia measured radiographically at each of three different levels in the bone had a statistically significant correlation with the total incidence of stress fractures as well as with those in the tibia alone or the femur alone. A narrow tibial width was shown to be a risk factor, but cortical thickness was not found to be significant.

Femoral Fractures↗
PubMed1987

NSAID induced avascular necrosis and arthropathy of femoral head.

The authors present the case of an 81-year-old woman with pain in her left hip. X-ray showed moderate osteoarthritic changes. The patient was prescribed diclofenal sodium (Voltaren), a nonsteroidal anti-inflammatory drug (NSAID). The patient continued use of the drug and returned 18 months later complaining of severe hip pain and difficulty in walking. X-ray, at that time, showed necrosis of the femoral head with subluxation and formation of a pseudoacetabulum. Total hip replacement was performed and the patient resumed normal daily activity. The authors point out that avascular necrosis of the femoral head, a known complication of steroid therapy, can also be caused by NSAID therapy and urge physicians to be aware of this complication.

Aged↗
PubMed1987

Osteolytic osteogenic sarcoma of ilium in 46-month-old boy.

A 46-month-old boy with a four-day history of pain and swelling over the right posterior ilium was thought to have acute osteomyelitis on the basis of a normal pelvic x-ray, markedly increased scintigraphic activity in the right ilium, and a mildly elevated sedimentation rate. At surgery, no signs of osteomyelitis were found, and biopsy revealed osteolytic osteogenic sarcoma. This is the youngest child with osteogenic sarcoma of the pelvic reported in the literature.

Bone Neoplasms↗
PubMed1987

Clinical significance of nonfocal scintigraphic findings in suspected tibial stress fractures.

The clinical significance of nonfocal increased uptake on skeletal scintigraphy in suspected tibial stress fractures is controversial, because it may represent either bone reaction to stress or a stress fracture in evolution. The scintigraphic evolution of areas of abnormal tibial activity, graded according to a 1 to 4 rating system and their corresponding clinical courses, were analyzed in 27 military recruits, as part of a prospective study. Disappearance of pain correlated with scintigraphic healing and increased pain with progression to stress fracture. Decreased or persistent pain had equivocal scintigraphic correlation. Eight of 14 nondiscrete scintigraphic lesions disappeared in spite of continuous training by the recruits; four such lesions, however, progressed to stress fractures. This uncertainty of progression suggests that military recruits and people training for sports who have such scintigraphic activity should have a brief rest period and proper monitoring before resuming training.

Adolescent↗
PubMed1987

External rotation of the hip. A predictor of risk for stress fractures.

External rotation of the hip was found to have a statistically significant correlation with the incidence of stress fractures, in a prospective study among Israeli infantry recruits of possible anthropomorphic predictors of risk for stress fractures. Soldiers in whom hip external rotation was greater than 65 degrees were at a higher risk for tibial and total stress fractures than those with external rotations of less than 65 degrees. The mean hip external rotation in this study of 57 degrees +/- 9.3 degrees was higher than in statistics reported in the American literature. The existence of a larger subpopulation with hip external rotation greater than 65 degrees may partially explain why the reported incidence of stress fractures in the Israeli army is higher than that of the American army.

Adolescent↗
PubMed1986

Femoral fracture treatment in head-injured children: use of external fixation.

Seven cases of femoral fractures in head-injured children with spasticity and/or decerebrate posturing and seizures were treated with external fixation. The fractures healed with good alignment, maintenance of length, and without infection. The technique is recommended both for its simplicity and lack of complications relative to other management approaches.

Child↗
PubMed1986

Stress fractures of the medial femoral condyle.

Three military recruits who presented with medial joint line pain and positive Appley grinding tests were found on the basis of scintigrams plus arthroscopy and/or arthrogram to have no intra-articular pathology, but rather medial femoral condyle stress fractures. The importance of the differential diagnosis is emphasized.

Adolescent↗