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Stressfrakturen im militärischen Kontext

Stress fractures in the military context

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Zusammenfassung

Hintergrund

Soldaten sind berufsbedingt, insbesondere als Rekruten, durch das Marschieren und exzessiven Laufsport deutlich erhöhten repetitiven Belastungsmustern am Fuß ausgesetzt. Dies kann zu militärspezifischen Stressfrakturen der Mittelfußknochen führen – den Marschfrakturen. Behandlung und Prävention dieser Frakturen haben im militärischen Kontext aufgrund ihrer Auswirkungen auf Verwendungsfähigkeit und Behandlungskosten eine besondere Bedeutung. Eine einheitliche Klassifikation dieser Frakturen besteht bislang nicht.

Fragestellung

Übersichtsarbeit über Stressfrakturen im militärischen Kontext mit Darstellung der Inzidenz, Risikofaktoren, Klassifikationen, Therapie- und Präventionsmöglichkeiten.

Material und Methode

Es erfolgte die PubMed®-basierte Auswertung der aktuellen Literatur über Stressfrakturen im militärischen Kontext und die Diskussion der Ergebnisse mit Fokus auf spezifisch militärmedizinische Behandlungsmöglichkeiten.

Ergebnisse

Es gibt unterschiedliche Klassifikationen, um Stressfrakturen einzuteilen; die bekannteste ist die MRT-basierte 4‑stufige Einteilung. Präventions- und Therapiemöglichkeiten sind vielfältig, aber bislang unzureichend validiert.

Diskussion

Militärspezifische Stressfrakturen sollten nach einer 4‑stufigen und MRT-basierten Klassifikation eingeteilt werden. Die Therapieoptionen umfassen sowohl konservative als auch operative Maßnahmen und sollten unter Berücksichtigung des individuellen Anforderungsprofils eingesetzt werden. Präventionsmaßnahmen kommt im militärischen Kontext eine tragende Rolle zu. Sie umfassen die Anpassung von Screeningtools, Ausbildung und Ausrüstung und bedürfen einer kontinuierlichen Evaluation und Weiterentwicklung.

Abstract

Background

Soldiers, especially as recruits, are exposed to significantly elevated stress patterns of the foot due to occupation-related marching and excessive running. This can lead to military-specific stress fractures of the metatarsals, i.e., marching fractures. The treatment and prevention of stress fractures are of particular importance in the military context due to the impact on operational capability and treatment costs. A uniform classification of these fractures does not yet exist.

Objective

Review of stress fractures in the military setting with presentation of the incidence, risk factors, classification, treatment and prevention possibilities.

Material and methods

A PubMed®-based review of the current literature on stress fractures in the military context was conducted and the results were discussed with a focus on specific military medical treatment options.

Results

There are several possibilities to classify stress fractures, the most well-known being a 4-level magnetic resonance imaging (MRI)-based classification. Prevention and treatment possibilities are multifaceted but so far insufficiently validated.

Conclusion

Military-specific stress fractures should be grouped according to a 4-level and MRI-based classification. The treatment options include both conservative and surgical measures and should be implemented taking the patient’s individual requirements into account. Preventive measures play a key role in the military context. They include the adaptation of screening tools, training and equipment and require continuous evaluation and development.

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Author information

Authors and Affiliations

  1. Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland

    Matthias Ring & Gerhard Achatz

  2. Zentrales Klinisches Management, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland

    Benedikt Friemert

  3. Klinik für Radiologie und Neuroradiologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland

    Carsten Hackenbroch

Authors
  1. Matthias Ring
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  2. Benedikt Friemert
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  3. Carsten Hackenbroch
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  4. Gerhard Achatz
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Corresponding author

Correspondence to Matthias Ring.

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Interessenkonflikt

M. Ring, B. Friemert, C. Hackenbroch und G. Achatz geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Thomas Mittlmeier, Rostock

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Ring, M., Friemert, B., Hackenbroch, C. et al. Stressfrakturen im militärischen Kontext. Unfallchirurgie 126, 856–862 (2023). https://doi.org/10.1007/s00113-023-01375-0

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  • DOI: https://doi.org/10.1007/s00113-023-01375-0

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