Recurrent stress fractures in military recruits. One-year follow-up of 66 recruits

Of 66 recruits who sustained stress fractures during basic training and returned to training after a period of rest, seven (10.6%) suffered recurrent fractures within one year. None of the recurrences was at the original anatomical site. All of the recruits with recurrent stress fractures had had at least one of their initial stress fractures in the femur. This suggests that a femoral stress fracture carries a high risk of recurrence at other sites.

Prophylactic oophorectomy in premenopausal women with stage II breast carcinoma

Prophylactic oophorectomy, as an additional treatment for stage II breast cancer, is controversial. In a retrospective study, a group of 37 premenopausal women with stage II infiltrating duct carcinoma and one to three positive axillary lymph node involvement after modified radical mastectomy and bilateral oophorectomy were compared to a matched group of 34 women treated by modified radical mastectomy only. Prophylactic oophorectomy prolonged the disease free interval significantly as compared to the control group. However, it did not prolong survival. This raises the question whether the prolongation of survival achieved by late oophorectomy in women with advanced breast cancer is preferable to an improvement in quality of life resulting from longer disease free intervals.

Stress fractures of the medial femoral condyle

Three military recruits who presented with medial joint line pain and positive Appley grinding tests were found on the basis of scintigrams plus arthroscopy and/or arthrogram to have no intra-articular pathology, but rather medial femoral condyle stress fractures. The importance of the differential diagnosis is emphasized.

The normal range of subtalar inversion and eversion in young males as measured by three different techniques

In a prospective study, 272 males aged 18 to 20 had goniometric measurement of their subtalar inversion and eversion by three different methods. Placing the ankle in dorsiflexion while performing the measurements decreased the mean inversion from 32 to 22 degrees but had little effect on eversion. The neutral position of the subtalar joint was found to have a mean value of 3 degrees of varus from the midpoint of the tibia. The technique for measuring subtalar motion as described by the Committee for the Study of Joint Motion of the American Academy of Orthopaedic Surgeons has less subjective variables than the other two methods used in this study. Its use is therefore recommended if comparisons are to be made between series.

Stress fractures in military recruits. A prospective study showing an unusually high incidence

In a prospective study of 295 male Israeli military recruits a 31% incidence of stress fractures was found. Eighty per cent of the fractures were in the tibial or femoral shaft, while only 8% occurred in the tarsus and metatarsus. Sixty-nine per cent of the femoral stress fractures were asymptomatic, but only 8% of those in the tibia. Even asymptomatic stress fractures do, however, need to be treated. Possible explanations for the unusually high incidence of stress fractures in this study are discussed.

A prospective study of the effect of a shock-absorbing orthotic device on the incidence of stress fractures in military recruits

In a prospective study of stress fractures the hypothesis that a shock-absorbing orthotic device worn within military boots could lessen the incidence of stress fractures was tested. The incidence of metatarsal, tibial, and femoral stress fractures was lower in the orthotic group, but only the latter difference was statistically significant. The time of onset and the location of stress fractures between orthotic and nonorthotic users did not differ. These findings suggest that the incidence of femoral stress fractures, which are the most dangerous type of stress fracture because of their high risk of developing into displaced fractures, can be reduced by an orthotic device.

Multiple stress fractures. A longitudinal study of a soldier with 13 lesions

A highly motivated 18-year-old man continued vigorous military training in spite of the presence of 11 stress fractures and subsequently developed two additional stress fractures. Scintigraphy over 27 weeks illustrated simultaneous regression and progression in his individual multiple foci. When stress fracture foci were not in anatomic locations prone to evolve to gross fractures, healing occurred despite vigorous activities and pain.

Negative bone scans in impending tibial stress fractures. A report of three cases

Three highly motivated military recruits who presented with tibial pain on exertion are reported. Their initial bone scan assessments to rule out stress fracture were normal, and the recruits were returned to demanding training. One month later, because of persistent and increasing tibial pain, they were rescanned and focal activity representative of tibial stress fractures was found in each case. Until now it has been assumed that a negative bone scan ruled out a stress fracture unequivocally. Our reported cases show that bone pain may in fact precede scintigraphic evidence of a stress fracture. Persistent and increasing bone pain during demanding physical activity, even in the presence of a prior normal bone scan, may represent stress fracture and repeat bone scan may be indicated.