BONE STRESS INJURIES IN THE ARMY CADETS OF PAKISTAN MILITARY ACADEMY
AbstractBackground: Bone stress injuries are common among army cadets during training period andthese injuries give rise to morbidity and loss of training hours. Some cadets with stress fracturesre-join their duties while some are kept out of services resulting in attrition and economic loss. Aretrospective analysis of bone stress injuries of one hundred and twenty cadets between June 2006and Dec 2007 was conducted from the case documents available at Institute of Nuclear Medicine,Oncology & Radiotherapy (INOR) Abbottabad. Results: The occurrence of stress fractures amongcadets at Pakistan Military Academy, presenting with exercise induced pain was 68.3% amongstthese cadets. Seventy fours percent f the fractures were labelled grade-I. High grade fractures wereconfined to tibia. Tibia was the commonest site of stress fractures in both sexes, accounting forabout 73% of all stress fractures. Fifty percent of these patients were labelled as having shinsplints and 3% as thigh splints. Conclusions: Most of the stress injuries were confined to the tibia.The referral was considered early as most of the stress injuries were of low grade.Keywords: Bone Stress, Stress fractures
Belkin SC. Stress Fractures in athletes. Orthop Clin North Am
Markey KL. Stress fractures. Clin Sport Med 1987;4:405–25.
Anderson MW, Greenspan A. Stre ss fractures. Radiology
Churches AE, Howlett CR. Functional adaptation of bone in
response to sinusoidal varying controlled compressive loading
of the ovine matacarpus. Clin Orthop 1982;168:265–80.
Jones BH, Harris JM, Vinh TN, Rubin C. Exercise-induced
stress fractures and stress re actions of bone: epidemiology,
etiology, and classification. Exerc Sport Sci Rev
Fazzalari NL. Trabecular micro fracture. Calcif Tissue Int
Li G, Zhang S, Chen G, Chen H, Wang A. Radiographic and
histologic analyses of stress fracture in rabbit tibias. Am J
Sports Med 1985;13:285–95.
Frost HM. Some ABC’s of skelet al pathophysiology. V.
Microdamage physiology. Calcif Tissue Int 1991;49:229–31.
Frost HM. Wolff’s Law and bone’ s structural adaptations to
mechanical usage: an overview for clinicans. Angle Orthod
Sallis RE, Jones K. Stress fractures in athletes: how to spot this
underdiagnosed injury. Postgrad Med 1991;89:185–8,191–2.
Greaney RB, Gerber FH, Laughli n RL, Kmet JP, Metz CD,
Kilcheski TS, et al. Distribution and natural history of stress
fractures in U.S. Marine recruits. Radiology 1983:;46:;339–46.
Maurer AH, Chen DC, Camargo EE, Wong DF, Wagner HN
Jr, Alderson PO. Utility of three-phase skeletal scintigraphy in
suspected osteomyelitis: concise communication. J Nucl Med
Greyson ND, Tepperman PS. Thre e-phase bone studies in
hemiplegia with reflex sympathetic dystrophy and the effect of
disuse. J Nucl Med 1984;25:423–9.
Zwas ST, Elkanowitch R and Fra nk G. Interpretation and
Classification of Bone Scintig raphic Findings in Stress
Fractures. J Nucl Med 1987;28:452–7.
Van Der Wall H and Kannangara S. Trauma and sports injuries
In: Clinical Nuclear Medicine, 4 th ed. Cary, NC: Oxford
University Press, 2006;263–79.
Sahi T, Peitso A, Laapio H. The incidence of stress fractures
[In Finnish]. In: Koskenvuo K, Sahi T, Peitso A eds. Military
health and medical care. 3rd e d. Karisto Oy: Hämeenlinna,
; p 208–11.
Almeida SA, Williams KM, Shaffer RA, B rodine SK.
Epidemiological patterns of mu sculoskeletal injuries and
physical training. Med Sci Sports Exerc 1999;31:1176–82.
Beck TJ, Ruff CB, Mourtada FA, Shaffer RA, MaxwellWilliams K, Kao GL, et al. Dual-energy X-ray absorptiometry
derived structural geometry for stress fracture prediction i n
male U.S. Marine Corps recruit s. J Bone Miner Res
Shaffer RA, Brodine SK, Almeida SA, Williams KM, Ronaghy
S. Use of simple measures of physical activity to predict stress
fractures in young men undergoing a rigorous physical training
program. Am J Epidemiol 1999;149:236–42.
Kelly EW, Jonson SR, Cohen ME, Shaffer R. Stress fractures
of the pelvis in female navy r ecruits: an analysis of possible
mechanisms of injury. Mil Med 2000;165:142–6.
Zwas ST, Elkanovitch R, and Fr ank G. Interpretation and
classification of bone scintigraphic findings in stress fractures;
J Nucl Med 1987;28:452–7