Sex Differences in the Incidence and Risk of Ankle–Foot Complex Stress Fractures Among U.S. Military Personnel

Background: The objective of this study was to evaluate sex differences in the incidence and risk of ankle–foot complex (AFC) stress fractures among U.S. military personnel, which could assist in developing management strategies as females assume a greater role in U.S. military operations. Methods: The Defense Medical Epidemiological Database was used to identify all diagnosed AFC stress fractures in military personnel from 2006 to 2015. Cumulative incidence of AFC stress fractures was calculated and compared by year, service branch, and military rank. Sex differences in the risk of AFC stress fractures by occupation were examined, and integrated (i.e., male and female) occupations were compared with non-integrated (i.e., male–only) occupations. Results: A total of 43,990 AFC stress fractures were identified. The overall incidence rate was 2.76 per 1,000 person-years for males and 5.78 per 1,000 person-years for females. Females consistently had higher incidence of AFC stress fractures across all subgroups, particularly among enlisted personnel. Female enlisted service members had the highest risk of AFC stress fractures in aviation [relative risk (RR) = 5.74; 95% confidence interval [CI] 4.80–6.87] and artillery/gunnery (RR = 5.15; 95% CI 4.62–5.75) occupations. Females in integrated occupations had significantly higher rates of AFC stress fractures than males in both integrated and non-integrated occupations (i.e., special forces, infantry, and mechanized/armor). Conclusions: Females in the U.S. military have a higher risk of AFC stress fractures than males. As integration of females into previously sex-restricted occupations continues, focused prevention efforts may be needed to reduce injury burden and maximize medical readiness.

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Stress Fractures in Military Personnel of Turkish Army

Sports Injuries ◽

10.1007/978-3-642-15630-4_108 ◽

2011 ◽

pp. 853-857

Author(s):

Mustafa Başbozkurt ◽

Bahtiyar Demiralp ◽

H. Atil Atilla

Keyword(s):

Military Personnel ◽

Stress Fractures

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Stress Fracture of the Lateral Cuneiform Bone

Journal of the American Podiatric Medical Association ◽

10.7547/1030337 ◽

2013 ◽

Vol 103 (4) ◽

pp. 337-339 ◽

Cited By ~ 4

Author(s):

Tamara Vukic ◽

Alan Ivkovic ◽

Sasa Jankovic

Keyword(s):

Stress Fracture ◽

Military Personnel ◽

Similar Case ◽

Stress Fractures ◽

Overuse Injuries ◽

Foot Pain ◽

Review Of The Literature ◽

Cuneiform Bone

Stress fractures are common overuse injuries of the bone that are most often seen in athletes and military personnel. These types of injuries seem to be commonly missed or delayed in diagnosis. Physicians should consider the possibility of such an injury while determining the diagnosis of a long-lasting foot pain. The aim of this paper was to report an isolated stress fracture of the lateral cuneiform bone. A review of the literature failed to find a similar case. (J Am Podiatr Med Assoc 103(4): 337–339, 2013)

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Prediction of Metatarsal Stress Fracture Location: Parametric Analysis of the Foot Using FEA

ASME 2011 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2011-53482 ◽

2011 ◽

Author(s):

Raymond G. Chen ◽

Adam Edelhauser ◽

Charles J. Gatt ◽

Noshir A. Langrana

Keyword(s):

Ultimate Strength ◽

Stress Fracture ◽

Military Personnel ◽

Parametric Analysis ◽

Stress Fractures ◽

Sports Activity ◽

Training Conditions ◽

Metatarsal Bones ◽

Bending Stresses ◽

The Military

Metatarsal stress fractures occur in 1.0–2.6% of all NCAA athletes and 1.0–1.7% of all soldiers in the military (1). The metatarsal bones are susceptible to stress fractures due to repeated musculoskeletal loading from running, jumping and sudden movements during sports activity and extreme training conditions for military personnel. The loads create bending stresses on the metatarsals at sub-ultimate strength values that create microcracks on the bones, which may propagate into stress fractures (2) if proper precautions are not taken.

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Prevalence of Radiographic Findings Consistent With Femoroacetabular Impingement in Military Personnel With Femoral Neck Stress Fractures

Journal of Surgical Orthopaedic Advances ◽

10.3113/jsoa.2013.0054 ◽

2013 ◽

Vol 22 (01) ◽

pp. 54-58 ◽

Cited By ~ 11

Author(s):

Timothy Carey ◽

Christian Key ◽

David Oliver ◽

Timothy Biega ◽

John Bojescul

Keyword(s):

Femoral Neck ◽

Femoroacetabular Impingement ◽

Military Personnel ◽

Stress Fractures ◽

Radiographic Findings

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

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph19010422 ◽

2021 ◽

Vol 19 (1) ◽

pp. 422

Author(s):

Grace M. Lennox ◽

Patrick M. Wood ◽

Ben Schram ◽

Elisa F. D. Canetti ◽

Vini Simas ◽

...

Keyword(s):

Risk Factors ◽

Military Personnel ◽

Data Extraction ◽

Stress Fractures ◽

Modifiable Risk Factors ◽

Eligibility Criteria ◽

Menstrual Dysfunction ◽

Increased Risk ◽

Modifiable Factors ◽

Repetitive Stress

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.

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