Stress Fractures of the Lower Limb in Military Personnel (Literature Review)

Abstract

Summary. Stress fractures are a common pathology among military personnel, occurring with a frequency of 1.5% to 31%, depending on the studied contingents. Fractures of the lower limbs occur more often, leading to impaired function and a long-term decrease in working capacity, which determines the medical, social, and economic significance of the problem. The issues of timely diagnosis and optimal treatment of stress fractures of the lower extremities in order to minimize the time of return to military service remain undefined. Objective: an analysis of the literature devoted to stress fractures of the lower limb in military personnel. Material and Methods. A search in PubMed databases from 1952 to 2023 using the search strategy “stress fractures in militaries” was conducted. Results. 671 publications were found and a significant increase in their number (249) over the past 7 years was noted; meta-analyses were 4 and randomized controlled studies were 28. Other publications belong to III and IV levels of evidence. Among all publications, only 401 were related to stress fractures of the lower extremities in military personnel. Conclusions. Stress fractures occur when increased and repeated load is applied to normal bone, which leads to microdamages and fractures. The etiology of stress fractures is multifactorial. The main complaints are localized pain with or without swelling and tenderness on palpation, aggravated by physical exertion. Early diagnosis is critical and is based on a careful history, orthopedic examination, and evaluation of appropriate imaging modalities. Classification of stress fractures based on type, location, and risk is important for determining treatment strategy. The analysis of the literature indicates a lack of protocols for the treatment and prevention of stress fractures of the lower extremities in military personnel. However, modern literature in this area is mostly of low quality and consists of studies of a small sample. This necessitates further research, especially in terms of prevention and surgical treatment.