Diagnosis of Stress fractures in military trainees: a large-scale cohort

Shapiro, Michael C.; Zubkov, K; Landau, Regev

doi:10.1136/bmjmilitary-2020-001406

Cited by 9 publications

(7 citation statements)

References 22 publications

(42 reference statements)

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“…Despite the fact that the clinical prevalence of stress fractures decreased after 8 weeks, incident lower limbs stress fractures persisted for over 20 weeks [8]. Actually, the incidence of stress fractures were higher in female soldiers than men [6].…”

Section: Introductionmentioning

confidence: 95%

“…Then, in 1897 Stechow found an evidence of fractures on imaging, so he called these fractures by "march fractures" [3,5]. The incidence of stress fractures among military recruits has been estimated to be in the range of 1.9%-31% [6]. In other studies, reported in India the incidences were 11.4% and 7.04% in two different military training centers, The occurrence of SFs was higher during their initial training period and reached its peak at 12 weeks of training [7].…”

Section: Introductionmentioning

confidence: 99%

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Knowledge Assessment of Stress Bone Fractures among Soldiers in Saudi Arabia

Albaker

Taha

Alkadi

et al. 2021

JPRI

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Background: Stress fractures are well perceived in military preparing and athletes. Aside from knowledge of the frequency of these fractures and their impact on the economy and lost training hours, there are just a few studies in Saudi Arabia that show the real incidence of these fractures. The precise incidence must be known in order to provide recommendations for future preventative initiatives. This study aims to assess the knowledge of stress fractures among Saudi soldiers. Methodology: An observational cross-sectional study was conducted in medical centers; these centers are located in Saudi Arabia on male and female patients of all ages who are in Saudi military society to assess the knowledge of stress fractures among Saudi military society. Data collection was done by questionnaire that distributed between Saudi soldiers. Data was entered and analyzed using (SPSS) program, version 20 (IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.). Results: Of all 1178 studied participants, 51.5% aged between 20- 30 years old. 91.7% were males. 47.5% of all participants had never heard of stress fractures before, 26.2% heard about it when joined military and 17.4% heard about it before joining the military field. 20.8% of all participants had stress fractures before, 10.4% were diagnosed through x-rays and medical history with the doctor, 4.6% were diagnosed through medical history only, and 2.4% diagnosed themselves. 85.3% of all participants agreed that stress fractures occur due to repetitive loading on the bones, 76.6% agreed that predominance of stress fractures of the lower extremities, over fractures of the upper extremities, 67.6% reported that stress fractures can be treated with painkillers, physiotherapy and reduce the risk and 78.6% agreed that stress fractures can be prevented by wearing appropriate footwear. Conclusion: Participants and relatively good knowledge of stress fractures. Knowledge of stress fracture was significantly associated with years of experience of participants, military sector, and residence area in the kingdom.

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Section: Introductionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Knowledge Assessment of Stress Bone Fractures among Soldiers in Saudi Arabia

Albaker

Taha

Alkadi

et al. 2021

JPRI

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“…Symptoms increase progressively, culminating in failure of loading or the need to stop the physical activity. SFs should be differentiated from insufficiency fractures that result from normal load on a pathological bone ( 1 , 2 ). This narrative review will explore the main aspects of SFs, including risk factors, pathophysiology, evaluation, and treatment.…”

Section: Introductionmentioning

confidence: 99%

Stress fractures

Costa¹,

Borba²,

Corrêa³

et al. 2022

Archives of Endocrinology and Metabolism

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Stress fractures (SF) represent 10%-20% of all injuries in sport medicine. An SF occurs when abnormal and repetitive loading is applied on normal bone: The body cannot adapt quickly enough, leading to microdamage and fracture. The etiology is multifactorial with numerous risk factors involved. Diagnosis of SF can be achieved by identifying intrinsic and extrinsic factors, obtaining a good history, performing a physical exam, and ordering laboratory and imaging studies (magnetic resonance imaging is the current gold standard). Relative energy deficiency in sport (RED-S) is a known risk factor. In addition, for women, it is very important know the menstrual status to identify long periods of amenorrhea in the past and the present. Early detection is important to improve the chance of symptom resolution with conservative treatment. Common presentation involves complaints of localized pain, with or without swelling, and tenderness on palpation of bony structures that begins earlier in training and progressively worsens with activity over a 2-to 3-week period. Appropriate classification of SF based on type, location, grading, and low or high risk is critical in guiding treatment strategies and influencing the time to return to sport. Stress injuries at low-risk sites are typically managed conservatively. Studies have suggested that calcium and vitamin D supplementation might be helpful. Moreover, other treatment regimens are not well established. Understanding better the pathophysiology of SFs and the potential utility of current and future boneactive therapeutics may well yield approaches that could treat SFs more effectively.

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“…Stress fractures, either partial or complete, are common overuse injuries caused by a repetitive submaximal bone loading [ 1 ]. The location of the stress fracture varies from sport to sport, but is most commonly observed in the lower extremities [ 2 , 3 ]. They are particularly common in the physically active individuals including but not limited to track and field athletes, long distance runners, dancers, and military recruits [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…The location of the stress fracture varies from sport to sport, but is most commonly observed in the lower extremities [ 2 , 3 ]. They are particularly common in the physically active individuals including but not limited to track and field athletes, long distance runners, dancers, and military recruits [ 2 , 3 ]. The prevalence of stress fractures is estimated to be between 6.5–9.7% among athletes of different sport disciplines [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Vitamin D and Stress Fractures in Sport: Preventive and Therapeutic Measures—A Narrative Review

et al. 2021

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There are numerous risk factors for stress fractures that have been identified in literature. Among different risk factors, a prolonged lack of vitamin D (25(OH)D) can lead to stress fractures in athletes since 25(OH)D insufficiency is associated with an increased incidence of a fracture. A 25(OH)D value of <75.8 nmol/L is a risk factor for a stress fracture. 25(OH)D deficiency is, however, only one of several potential risk factors. Well-documented risk factors for a stress fracture include female sex, white ethnicity, older age, taller stature, lower aerobic fitness, prior physical inactivity, greater amounts of current physical training, thinner bones, 25(OH)D deficiency, iron deficiency, menstrual disturbances, and inadequate intake of 25(OH)D and/or calcium. Stress fractures are not uncommon in athletes and affect around 20% of all competitors. Most athletes with a stress fracture are under 25 years of age. Stress fractures can affect every sporty person, from weekend athletes to top athletes. Stress fractures are common in certain sports disciplines such as basketball, baseball, athletics, rowing, soccer, aerobics, and classical ballet. The lower extremity is increasingly affected for stress fractures with the locations of the tibia, metatarsalia and pelvis. Regarding prevention and therapy, 25(OH)D seems to play an important role. Athletes should have an evaluation of 25(OH)D -dependent calcium homeostasis based on laboratory tests of 25-OH-D3, calcium, creatinine, and parathyroid hormone. In case of a deficiency of 25(OH)D, normal blood levels of ≥30 ng/mL may be restored by optimizing the athlete’s lifestyle and, if appropriate, an oral substitution of 25(OH)D. Very recent studies suggested that the prevalence of stress fractures decreased when athletes are supplemented daily with 800 IU 25(OH)D and 2000 mg calcium. Recommendations of daily 25(OH)D intake may go up to 2000 IU of 25(OH)D per day.

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Diagnosis of Stress fractures in military trainees: a large-scale cohort

Cited by 9 publications

References 22 publications

Knowledge Assessment of Stress Bone Fractures among Soldiers in Saudi Arabia

Knowledge Assessment of Stress Bone Fractures among Soldiers in Saudi Arabia

Stress fractures

Vitamin D and Stress Fractures in Sport: Preventive and Therapeutic Measures—A Narrative Review

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