Non-Modifiable Risk Factors for Stress Fractures in Military Personnel Undergoing Training: A Systematic Review.

Grace M Lennox,Rodney Pope,Vini Simas,Ben Schram,Elisa F D Canetti,Robin Orr,Patrick M Wood

doi:10.3390/ijerph19010422

Abstract

A fracture, being an acquired rupture or break of the bone, is a significant and debilitating injury commonly seen among athletes and military personnel. Stress fractures, which have a repetitive stress aetiology, are highly prevalent among military populations, especially those undergoing training. The primary aim of this review is to identify non-modifiable risk factors for stress fractures in military personnel undergoing training. A systematic search was conducted of three major databases to identify studies that explored risk factors for stress fractures in military trainees. Critical appraisal, data extraction, and a narrative synthesis were conducted. Sixteen articles met the eligibility criteria for the study. Key non-modifiable risk factors identified were prior stress fracture and menstrual dysfunction, while advancing age and race other than black race may be a risk factor. To reduce the incidence of stress fractures in military trainees, mitigating modifiable risk factors among individuals with non-modifiable risk factors (e.g., optimising conditioning for older trainees) or better accommodating non-modifiable factors (for example, extending training periods and reducing intensity to facilitate recovery and adaptation) are suggested, with focus on groups at increased risk identified in this review.

Highlights

A fracture, being an acquired rupture or break of bone, is a significant and debilitating injury commonly seen among athletes and military personnel [1]
Patients will usually describe a sudden increase in physical activity or load, without adequate rest or time for the bone to adapt to stresses and build tolerance [4,5]
Stress fractures are generally confirmed through radiographs (X-ray), Magnetic Resonance Image (MRI), or bone scintigraphy, with the latter considered the gold standard for stress fracture diagnosis [6]

Summary

Introduction

A fracture, being an acquired rupture or break of bone, is a significant and debilitating injury commonly seen among athletes and military personnel [1]. The diagnosis of stress fractures typically involves a thorough patient history and physical examination. Patients will usually describe a sudden increase in physical activity or load, without adequate rest or time for the bone to adapt to stresses and build tolerance [4,5]. Additional common presentations involve complaints of tenderness on palpation of bony structures, and localised pain that tends to worsen as activity increases, and eases to an ache during rest. Stress fractures are generally confirmed through radiographs (X-ray), Magnetic Resonance Image (MRI), or bone scintigraphy (bone scans), with the latter considered the gold standard for stress fracture diagnosis [6]

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