Stress fractures of forearm bones in military recruits of rifle drill training

Background: Stress fractures rarely occur in the forearms. These injuries usually occur in healthy young patients, which are usually neglected by patients or physicians. Early diagnosis and treatment are important to avoid late complications of these fractures. The purpose of this study was to analyze a case series of military recruits who participated in rifle drill training and presented with forearm stress fractures at our institution. Methods: We evaluated 216 military recruits of rifle drill training. Twelve patients were diagnosed with forearm stress fractures by typical history, physical examination, laboratory studies, serial radiographs, and bone scan examinations. Results: Eighteen fractures were found in 12 patients. On initial radiographs, 11 had periosteal reactions, 4 had callus formation with complete fracture lines, and 3 were normal. All 18 fractures had increase radioactivity in the involved middle (15 of 18) or distal (2 of 18) ulnae and one middle radius (1 of 18). Conclusions: Stress fractures of the forearms in military rifle drill training usually occur in middle ulnae. Fifty percent of them were bilateral fractures. A high index of suspicion is the key to diagnosis. Early diagnosis with conservative treatment can achieve satisfactory results and avoid late complications of stress fractures.