March fracture of the tibia.

Abstract

Several reports have been published on “march” fracture of the tibia (3, 7, 8, 12, 14, 15, 16), but dealing usually isolated cases or small series. The same type of fracture of the metatarsals has been discussed in numerous publications (1, 4, 5, 6, 9, 10, 11, 13, 17), especially during World War II, with several large series of cases being presented. Having failed initially to recognize the first case of march fracture of the tibia encountered, and having seen 14 additional cases in a relatively short period of time, the author considered it appropriate again to call attention to this lesion, which is seldom seen in civilian life but is found with considerable frequency at any Army camp where a large number of recruits are undergoing strenuous military training. The tibia is second only to the metatarsals as the most common site of occurrence of this type of fracture. Krause (12), in reporting 4 cases observed among soldiers in active training, states that the most common location of the fracture is on the medial aspect of the diaphysis at the junction of the middle and upper third. Brandt (3), discussing this type of fracture in the German Army, reports that it usually occurs in the middle third of the tibia and mostly in infantry recruits. He attributes it to the upward swing of the leg with outstretched knee and recurving of the supporting leg during rigid marching. Roberts and Vogt (16) reported 12 cases of “pseudofracture” of the upper third of the tibia, without a history of trauma, in children ranging from four to sixteen years of age. The age range of 14 cases of “fatigue fracture” reported by Hartley (8) was similar, with practically all of the patients being children or young adults. Three of this group had bilateral fractures of the tibia. Ollonqvist (14), basing his report on twelve years of observation, stated that “march fractures” of the tibia occurred at the rate of 60 a year in the Finnish Army. He called the condition “osteopathia itineraria tibiae” and noted the presence of the fracture line. Pfahler (15) reported a single case of “insufficiency fracture” of the tibia in 1939, stating that it was the only case of such fracture he had seen, and noting its resemblance to an osteogenic sarcoma. The resemblance to osteogenic sarcoma was also noted by Hansson (7), who reported two fractures of this type in the femur and one in the tibia. The following cases are illustrative of march fracture of the tibia. Case I: A 17-year-old white male enlistee in basic infantry training was admitted to the hospital on Aug. 19, 1950, complaining of pain below the right knee of two weeks duration.