High Incidence of Stress Fractures in Military Cadets During Training: A Point of Concern

Abstract

Introduction: Stress fractures occur due to repetitive cumulative micro trauma on the bone over a period of time. Stress fractures in military cadets is a rising cause of concern. It increases morbidity, long periods of absence from training and economic losses.

Aim: The purpose of this prospective study was to determine the incidence and distribution of stress fracture (SFs) in Border Security Forces (BSF) cadets in Bangalore during their basic training tenure.

Materials and methods: A detailed analysis of history and physical assessment was performed of those presenting with symptoms of pain, swelling or deformity. These cadets then underwent radiographic imaging for the evaluation of symptoms. All cadets with clinical and radiological diagnosis of SFs were appropriately managed and followed up every two weeks till the time of union.

Results: Three hundred BSF candidates had clinical and radiological signs of SF with an overall incidence rate of 15%. The average age of the patients with SFs was 23 years (range 20-26). The incidence of SFs was highest during their physical training exercises and reached maximum at 12 weeks of the training schedule. Overall, the most common sites of bone injuries were the tibia (87.66%), fibula (7.8%), and metatarsals (2%). There were 5 femur fractures including one bilateral femur(1.67%) and two neck of femur (0.67%). Three tibia, three femur shaft and two neck femur fractures were operated and rest treated conservatively. All fractures healed in an average period of seven weeks. All cadets returned to their full activity in an average period of nine weeks.

Conclusion: The study provides evidence that SF among BSF cadets occur frequently during their training period with undoubtedly high incidence rate which is probably underrated in Indian setting. To prevent stress fractures, modifiable causes and risk factors must be identified and a proactive approach which can help the cadets withstand intense physical activity should be adopted.

Keywords: Border Security force (BSF); Fracture site; X-ray.

[Table/Fig-1]:

Percentage distribution of stress fractures according to clinic-radiological classification by Agarwal

[Table/Fig-2]:

Percentage distribution of stress fractures according to site involved

[Table/Fig-3,4]:

X-ray tibia fibula AP/LAT showing healed stress frature proximal 1/3^rd

[Table/Fig-5]:

X-ray pelvis with both femur showing bilateral femoral stress fractures

[Table/Fig-6&7]:

X-ray and ct right hip joint showing fracture neck femur

[Table/Fig-8]:

X-ray right hip of same patient, operated with Dynamic Hip Compression Screw

[Table/Fig-9]:

Percentage of site wise distribution of stress fractures