Fatigue fractures of tibial and femoral shaft in soldiers.

In 136 fatigue fractures in military recruits, 58 were in the femoral shaft and 43 were in the tibia. Fatigue fractures in the long bones of the lower limb can be classified on the extend of the periosteal reaction. Most were grade 1, showing periosteal reaction only on one or two cortices as seen on the anteroposterior and lateral projections of the roentgenograms. Physical activity was discontinued immediately when fatigue fracture of the femur or tibia was suspected on clinical grounds alone. Early clinical diagnosis the long bone fatigue fractures in all patients except one. The injured soldiers were ambulatory without plaster cast immobilization or crutches. The suggested classification was used to select patients with Grade 1 fatigue fracture for early resumption of active military training.