March (fatigue) fractures of the long bones of the lower extremity and pelvis

1. 1. March or “fatigue” fracture is primarily an occupational disease associated with military training. 2. 2. Because of the insidious nature of the disease, many cases of march fracture are overlooked by the uninitiated. 3. 3. Etiology is obscure, but the author believes, as in cases of march fracture of the metatarsals, that it is due to muscle fatigue or muscle imbalance. 4. 4. March fractures occur in specific areas of predilection. 5. 5. X-ray appearance is that of an “ice crack” fracture. 6. 6. Displacement of fragments is unusual except in the case of fracture of the neck of the femur, where, if the fracture is not protected from weight bearing, coxa vara commonly occurs. 7. 7. March fractures, even if incomplete and not of striking x-ray appearance, must be treated with great respect, and too early weight bearing should be prohibited. 8. 8. Ideal treatment of march fractures of lower extremity and pelvis is bed rest and prohibition of early weight bearing. In fractures of the neck of the femur, immobilization is indicated. 9. 9. No case of delayed or non-union was encountered. 10. 10. In 10,953 orthopedic cases seen in a period of nine months at an Army Station Hospital, twelve cases of march fracture of lower extremity and pelvis, excluding metatarsal march fractures, were encountered. 11. 11. Case histories of six march fractures of the tibia, one of the fibula, two of the femur, and three of the pelvis were reported.