Pelvic Stress Fracture among Naval Cadets in Bangladesh

Stress fractures are often found in military recruits. Most involved bones are tibia, metatarsals, calcaneus and fibula. Pelvic stress fracture especially at pubic ramus is relatively rare; however, it is found more in females in comparison to its male counterpart. A prospective study was carried out to investigate demographic features of pelvic stress fractures among the Naval cadets in Bangladesh. A total of 18 patients with pelvic stress fractures reported at the Department of Orthopedics of Bangladesh Naval Ship (BNS) Patenga Hospital at Chattogram, Bangladesh, between January 2021 and December 2022. Naval trainee officers both male and female undergo physical and military training during their courses. Most of the cadets reported with pain in their groin. Routine investigation was done. Plain radiograph of pelvis revealed fracture lines sometimes periosteal elevation and sclerosis. The mean age of the patients was 18.94 years (ranging between 18 and 20 years). Out of 18 patients, 17 were female and 1 was male. All the cadets were treated conservatively. Post trauma pain developed in 3(16.67%) cases, while the rest 15(83.33%) recovered completely.


Introduction
Stress fracture have been a documented problem in the military recruit near about 170 years, 1 occurring in 1 to 30% of trainees. 2,3During demanding military training, bone is subject to large mechanical stress. 4,5If this stress occurs repeatedly and with sufficient magnitude, leading to cyclical overload of the bone.Such an overload can cause stress fracture.
Stress fractures most frequently affect the lower extremities, most commonly involved bones are tibia, metatarsals, calcaneus and fibula. 7,8Pelvic stress fractures, however, are relatively rare, representing only 1 to 10% of all stress fractures reported. 9,10Stress fractures of the pelvis can be particularly devastating because of the increased healing time required compared with stress fractures at other sites.

Address of Correspondence:
Email: quader1974@gmail.compelvic girdle, and shorter legs compared with male. 3,13,15,18The purpose of the study was to investigate the demographic characteristics of pelvic stress fractures among the Naval cadets in Bangladesh.

Methods
This prospective study was done on a total of 18

Results
A total of 18 patients were treated during our study period.The mean age of the patient was 18.94 years (ranging between 18 and 20 years) (Table-I).17 were female and 1 was male (   11,13 Pelvic stress fractures were described in medical records of military professionals as early as in the 1940s. 10,190][21] The muscular pull theory is supported by the fact that stress fractures of the pelvis most frequently occur at the ramus (Fig. 1), which is the narrowest area of the pubic bone (Fig. 2) as well as the site for the origin of the adductor magnus. 22During the normal gait cycle, the medial portion of the CBMJ 2024 January: Vol. 13 No. 01 adductor magnus acts with the other adductor muscles to flex the hip, whereas its lateral fibers act with the hamstrings to extend the hip.and had smaller anthropometric dimensions than recruits who were injury free.They did not, however, differentiate by site of fracture, nor did they account for possible differences in the activities of recruits who did or did not develop stress fractures.Moreover, short stature is not an independent risk factor for pelvic stress fractures when individuals are allowed to walk, march or run at their natural pace and stride, for example, athletes who run at a natural stride length.Short stature does become a risk for pelvic stress fractures, when an individual is forced to "overstride," such as when marching in a formation of recruits aligned from tall to short.
patients with pelvic stress fractures who reported at the Department of Orthopedics of Bangladesh Naval Ship (BNS) Patenga Hospital at Chattogram, Bangladesh, between January 2021 and December 2022.Trainee officers both male and female undergo physical and military training in formation marching, running, and military drill.Stress fracture diagnoses were based on subjective complaint of atraumatic, insidious onset of pain and tenderness consistent with positive radiographic findings like periosteal elevation, sclerosis, or fracture line on plain film of pelvic x-ray of the naval cadets (as seen in Fig. 1 & 2).

Fig. 1 :
Fig. 1: Digital radiograph of a female patient (aged 20 years) demonstrating the typical location (pubic ramus) and appearance of a pelvic stress fracture (arrow mark)

Fig. 2 :
Fig. 2: Digital radiograph of a female patient (aged 19 years) showing the narrowest part of pubic bone (pubic ramus) which is the typical site of pelvic stress fracture (arrow mark)

Table - I
: Distribution of patients according to age group (n=18)