Body mass index (BMI) (calculated as weight (kg)/height (m)²) and height are linked to the pathogenesis of low back pain, but evidence-based confirmation is lacking. We examined the prevalence of low back pain in adolescents and its association with BMI and height. Disability clauses (official military limitations related to a person's health status) indicating low back pain severity were divided according to symptoms of low back pain alone and symptoms of low back pain with objective corroborating findings. All 829,791 males and females undergoing mandatory premilitary recruitment examinations since 1998 were included. Logistic regression models assessed the relationships of BMI and height with low back pain. Prevalence of low back pain was 0.2% for both males and females with objective findings and 5.2% for males and 2.7% for females without objective findings. Higher BMI was significantly associated with low back pain in males (for overweight, odds ratio = 1.097, P < 0.001; for obese, odds ratio = 1.163, P < 0.001) and in females (for overweight, odds ratio = 1.174, P < 0.001; for obese, odds ratio = 1.211, P < 0.001). Height was associated with increased risk of low back pain in both genders. Odds ratios for low back pain in the tallest group compared with the shortest group were 1.438 (P < 0.001) for males and 1.224 (P < 0.001) for females. Low back pain with or without objective findings was associated with overweight and obesity as well as with height.

Leadership, and more specifically medical leadership, is an unmeasured potential that has the power to influence every aspect of a person’s professional life and its challenges and is more evident in times of emergency. Medical leadership is receiving increasing recognition especially in discussing actions to be taken in times of stress and emergency. We propose a comprehensive conceptual model that examines the elements that build successful medical leadership, especially during emergency scenarios. The model is based on two sets of medical leadership capabilities and skills, while the first set is more relevant to everyday challenges, the second set represents abilities and characteristics that arise mostly during emergencies. The model gathers together the characteristics and abilities of the medical leader based on our unique personal experiences during conflicts, terror, civilian challenges and numerous humanitarian missions. This article suggests a framework for the foundations on which the medical leader’s education should be built and describes our perception of how to establish medical leadership, its unique elements and the processes leading to outstanding performance in times of emergency.

Objective: The objective of this study was to analyze our experience in treating femoral shaft fractures with different strategies, focusing on the first year after injury when the choice of method would have the greatest impact. Methods: We reviewed the medical records of all children treated for femoral shaft fractures in our institution between 1997 and 2010. They were divided according to therapeutic approach: spica cast, skin traction, titanium elastic nail (TEN), external fixator, intramedullary medullary nail (IMN), and plating. Results: The 212 patients included 150 boys and 62 girls (M/F ratio 2.4:1, mean age 5 years, range 0–16). The postoperative radiographic results demonstrated solid union in all patients, with no malunions. Of the 151 children in the spica cast group, 10 required re-manipulation and casting due to loss of reduction with unaccepted angulation, 10 had contact dermatitis, and 2 had fever and pressure sores. All 21 elastic nail group children underwent re-operation to remove the hardware: 3 had soft tissue irritation at the insertion points, and 3 had leg length discrepancy (LLD). Of the 14 external fixation patients, 4 had LLD, 1 had a pin tract infection, and 1 had a fracture through a pinhole after a fall. There were no complications in the 12 IMN patients, the 3 plating patients, or the 11 skin traction patients. LLD rates in the spica group were 10.5% higher compared to those in the control group (other treatment modalities) (P = .03). Conclusions: TEN treatment was superior to spica casting for children who had reached an average age of 4 years.

Anterior cruciate ligament and meniscal injuries are associated with secondary osteoarthrosis which may lead to functional impairment and economic burden. The prevalence of knee injury has not been studied in depth. Our purpose was to report the prevalence of knee ligament and meniscal injuries and their associations with gender, body mass index (BMI), and height in young adults and to characterize individuals with meniscal injuries who gained full recovery. A cross-sectional, population-based study was conducted. Information on the disability codes of knee ligament and meniscal injury according to the Regulations of Medical Fitness Determination was retrieved from a medical database containing records of young prerecruits into mandatory service. Logistic regression assessed the association between genders, BMI, and body height to knee injuries. A total of 825,187 subjects were included. Prevalence of knee injuries was 0.35%. Males had 2.2-fold more knee injuries than females. Increased BMI was associated with increased prevalence of knee injury in both genders, more significantly in females (overweight and obese females had an odds ratio of 1.406 and 1.519, respectively, to suffer from concomitant meniscal and ligamentous knee injury). Being underweight was associated with a lower prevalence of knee injury. An above normal BMI was more significantly associated with meniscal and/or ligament injuries that did not fully recover (females > males). Body height was associated with isolated meniscal injury in both genders. We found an association between BMI, body height, and knee injury in both males and females. Higher body height and higher BMI might be risk factors for knee injuries. Higher BMI was associated with greater probability of disability coding. Meniscal and ligament injuries are more common among males.

Objective: Examine Schober test’s (ST), Modified ST (MST), and Modified–Modified ST (MMST) surface markers’ accuracy in spanning lumbar L1-S1 motion segments and repeatability related to actual patient anatomy as measured on sagittal CT scans. Methods: The study included 25 patients of varying heights, weights, and gender without prior spinal surgery or deformity. Researchers assessed patients’ CT scans for ST, MST, and MMST skin levels of the measured cephalic and caudal endpoints. Results: The original ST failed to include at least one lumbar motion segment in all patients, omitting the L1-L2 motion segment in 17 patients and the L2-L3 in another eight. The additional cephalic length of the MST did not improve the inclusion of the actual L1-S1 components. The MMST measured 19 ‘patients’ entire L1-S1 motion segments, reaching a 76% accuracy rate. WMST, measuring 16 cm (instead of MMST’s 15 cm), improved the measurement significantly, measuring the L1-S1 motion segments in all cases (with 100% accuracy). Conclusion: ST and its modifications fail to span the L1-S1 motion segments and are thus prone to underestimating lumbar spine motion. This study shows that the WMST is much more accurate than previous modifications and is a better tool for evaluating lumbar spine motion.