Profile of pelvic stress fractures in Indian women during military training and approaches for prevention

Abstract

Introduction: Pelvic stress fractures have been reported commonly among women military trainees from worldwide. They have been reported as the most common stress fracture in women in Indian military training academies. With the recent increase in avenues for women to join the armed forces and other paramilitary forces, there is a need for medical personnel to be familiar with the epidemiology of pelvis stress fractures unique to women. This article presents a clinical and epidemiological profile of these fractures and suggests approaches for their prevention. Methods: Fifty-one cases of pelvic stress fractures were observed among a cohort of 608 women trainees in the military training establishments of the Indian, Army, Navy, and Air force. Data on clinical presentation, diagnosis, and management were collected for those women trainees who developed radiologically confirmed pelvic stress fractures. Information was also taken to identify the possible risk factors. Measures which can be implemented during training have been suggested to reduce the risk of these fractures during training. Results: All women trainees with stress fracture pelvis presented with groin pain and difficulty in running and drill usually in the 6–9th week of training. X-rays showed involvement of the inferior pubic ramus. All of them made good recovery with conservative management. A large number of training-related factors and certain individual-related anatomical and physiological factors seem to have a role specifically leading to these fractures. Approaches to minimize the risk of pelvic stress fractures have been recommended for making the changes in training and managing individual factors. Conclusion: Specific measures for the prevention of pelvic stress fractures are required to be instituted, addressing the risk factors for Indian women undergoing military training along with general measures.