Pulmonary embolism is a serious complication after arthroscopy of the knee, about which there is limited information. We have identified the incidence and risk factors for symptomatic pulmonary embolism after arthroscopic procedures on outpatients. The New York State Department of Health Statewide Planning and Research Cooperative System database was used to review arthroscopic procedures of the knee performed on outpatients between 1997 and 2006, and identify those admitted within 90 days of surgery with an associated diagnosis of pulmonary embolism. Potential risk factors included age, gender, complexity of surgery, operating time defined as the total time that the patient was actually in the operating room, history of cancer, comorbidities, and the type of anaesthesia. We identified 374 033 patients who underwent 418 323 outpatient arthroscopies of the knee. There were 117 events of pulmonary embolism (2.8 cases for every 10 000 arthroscopies). Logistic regression analysis showed that age and operating time had significant dose-response increases in risk (p < 0.001) for a subsequent admission with a pulmonary embolism. Female gender was associated with a 1.5-fold increase in risk (p = 0.03), and a history of cancer with a threefold increase (p = 0.05).

These risk factors can be used when obtaining informed consent before surgery, to elevate the level of clinical suspicion of pulmonary embolism in patients at risk, and to establish a rationale for prospective studies to test the clinical benefit of thromboprophylaxis in high-risk patients.

Introduction: Stress fractures comprise a major problem in female police or army recruits. The incidence of stress fractures is reported ranging from 3 to 10 fold when compared to male recruits taking the same training program. This study consisted of an intervention program aiming at reducing combat gear weight and locating the gear as close as possible to the body center of gravity.

Material and Methods: In a prospective study we followed up two companies of female recruits of the Israel Border Police. Both companies were followed for the four months of basic training using a basic data questionnaire inclusive of previous physical activity habits, previous acute and overuse injuries, menstrual history and previous smoking habits. An injury questionnaire was filled on commencement of the course and every two weeks thereafter. The clinical records of medic and doctor visits, as well as the personal medical file, were revised. Roentgenological and scintigraphic imaging were performed during the course, when clinical suspicion of a stress fracture arose.

The first company of 71 fighters used the standard combat gear amounting to 12.5 kg. The second company of 64 fighters used combat equipment weighing 9.4 kg, held in a combat girdle close to the body center of gravity, inclusive of a shorter personal combat riffle and personal combat vest.

Results: There was no difference in the number of clinic visits between the two companies. Complaints suggesting stress fractures were recorded in the first company from the 3^rd to the 8^th week of training and in the second from the 1^st to 3^rd week. The percentage of fighters sent for Scintigraphy because of clinical suspicion of stress fractures was 22.5% in the first company and 6.25% in the second. The percentage of fighters in whom stress fractures were located by Scintigraphy was 15.5% in the first company and 4.7% in the second. The number of stress fractures in average per fighter was 0.45 fractures in the first company and 0.27 fractures in the second. When calculating only “dangerous” stress fractures (long bones and navicular) there were noted 0.34 fractures per fighter in the first company and 0.20 in the second. Total average training days lost for reason of stress fractures was 2.21 per fighter in the first company and 1.08 in the second.

Conclusions: Reducing the weight of the fighting gear and securing it closer to the body center of gravity may have a positive effect in reducing the incidence of stress fractures in female recruits of fighting units during the intense basic training program.

Purpose: The elderly population is increasing in the modern world. Societies in general and medical personnel are facing new ethical and medical dilemmas when treating extremely old patients. Elderly patients have osteoporotic bone and hence a high incidence of fractures. Evaluating this unique group of patients who have hip fractures is our goal.

Materials and Methods: A retrospective analysis of all patients who had hip fractures between January 1990 and December 2001 and were beyond 100 years old was handled.

Data was collected from the medical files (hospitalization and out-patient charts) for age, sex, type of fracture, type of treatment, background disease, rehabilitation and time until death. The latter was confirmed by data from ministry of home office.

Results: 23 patients (17 females and 6 males) were found. Ages ranged from 100 and 107 (mean: 101.78). They had 4 subcapital and 19 per-subtrochanteric fractures. The patients had between 1–5 major background diseases. 4 patients were treated conservatively (1 due to major pneumonia and 3 refused the operative procedure). All these patients died at the same month of admission. Among the 19 patients who underwent operation, 12 patients have died and lived between 0–34 months (mean: 7.43) post-operatively, and 7 are still alive for 4–75 months (mean: 34.43) post-operatively. No differences between the operative and conservative groups in terms of major background disease were found.

Conclusions: Most of hip fractures in the extreme old age are per-subtrochanteric. Operative treatment yielded better results and should be the treatment of choice.

The importance of meniscal tears repair is discussed widely in the literature. The repair should be performed if the conditions promise some chance for healing. Due to technical difficulties many orthopaedic surgeons still prefer partial meniscectomy to meniscal repair.

We describe our techniques for meniscal repair. The described techniques could be used by any surgeon with basic skills in arthroscopic surgery. No special equipment is needed.

The basic equipment for this technique is a standard 18 gouge needle. The plastic cup of the needle is cut away in order to overcome the ridge between the plastic and the metal part of the needle, thus making the suture passage easier.

Following the arthroscopic identification of the meniscal tear and preparing the torn parts for repair, the place for the first suture is identified.

A 2–3 mm long skin incision is made. The subcutaneous tissue is bluntly developed to the capsule. The 18 gouge needle is past from outside-in in the desired point through the torn margins of the meniscus. The tip of the needle is emerged above or under the meniscal surface, depends on our decision of suture position.

1st step – Producing a loop outside the joint: Two ends of a nylon 2/0 suture are inserted through the needle into the joint cavity, and pulled out through one of the arthroscopic portals. The needle is removed. The result of this step is a nylon 2/0 suture passing through the torn parts of the meniscus with a loop outside the joint.

2nd step – Producing a double-loop inside the joint cavity: A second nylon 2/0 suture is passed through the first loop. The first suture is pulled into the joint. At this stage, both loops are inside the joint, holding each other. The free ends of the first loop are emerged through one of the arthroscopic portals, while the free ends of the second loop pass through the torn parts of the meniscus and emerge through the capsule.

3rd step – Producing the meniscal suture: A second 19 gouge needle is inserted close to the point of insertion of the first one, directed into the joint. The emerging point of this needle, on the meniscus, should be positioned according to the desired suture direction (transverse, vertical, or oblique). The tip of the needle is then directed into the “2nd” nylon loop (the “1st” nylon loop can assist at this stage). The loop is wrapped over the needle, and the 1st suture is removed.

PDS suture (1/0 or 2/0) is inserted through the needle until a 5 cm free end is positioned intra articular. The needle is removed with caution without pulling the PDS suture, leaving the

PDS free end inside the nylon loop. The nylon loop is used as a pooling tool for the PDS suture. Pulling the free end of the PDS suture out of the joint results in a PDS loop for the meniscal suture (in order to avoid iatrogenic tear of the meniscal tissue while pulling the sutures, a probe should be positioned under the PDS suture during the process). The PDS is tightened over the capsule. The technique is repeated as much as necessary for perfect repair of the meniscus.

The advantage of this method is that it does not necessitates unique equipment, but rather uses the ordinary arthroscopic tools and sutures. This method was used successfully upon large number of meniscal tears. We recommend its use routinely.

Background: Female recruits are known to have a relatively high incidence of stress fractures (SF). This has been apparent also when female recruits entered the Israel Border Police training program.

Aims: To examine the influence of various interventions including shoe modification, nutrition, controlled training program and pre-recruit course on the incidence of SF.

Methods: Between February 1996 and February 1998, five courses of female recruits were held with a total of 229 participants. The four later courses were controlled and strictly documented. These included 203 recruits. The total number of SF was recorded using bone scintigraphy. “Dangerous SFX” was described as those SF including the long bones of the lower limb and the navicular bone. Due to high number of SF the organic medical team introduced various interventions: 1. Shoes were replaced with lither and flexible shoes with soft absorbing soles (course I onward). 2. Nutrition was modified (course II onward). 3. A training scale was programmed and introduced (course III onward). 4. Selecting candidates six months before recruitment and running a three-month preparation course (course IV onward).

Results: 1) 55 recruits (of 203) or 27.1% suffered SF grade I or more (2.9 SF for injured recruit or 0.78 SF for each recruit in the course. 2) 36 recruits (of 203) or 17.7% suffered SF grade II or more (2.1 SF for injured recruit or 0.37 SF for each recruit in the course. 3) The data concerning 229 recruits along the 5 courses was recorded and found that the incidence of number of recruits suffering dangerous SF in all grades, or grade II or higher, and the number of dangerous SF per recruit was reduced gradually from course to course.

Conclusions: The incidence of stress fractures in female recruits during basic training is high, ranging in the series for the various courses from 23% to 35% for all grades and from 8.3% to 19% for “dangerous” SF (basically of the long bones) graded II onward. Various interventions including shoe modification, nutrition, controlled training program and pre-recruit course seems to have a possible combined effect in reducing the incidence and severity of stress fractures, especially those termed “dangerous stress fractures”.