The incidence and risk factors for the development of fractures in military populations: a systematic review

Objectives:
Traumatic fractures represent a considerable burden to military personnel across nations. Despite substantial research examining traumatic fracture incidence and risk factors, there is no comprehensive synthesis of evidence on traumatic bone fractures in military populations. This study aimed to identify and synthesise findings from studies reporting on the incidence of, and risk factors for, traumatic fractures in military personnel. Design: Systematic review.

Methods:
A structured search was performed in PubMed, EBSCO, CINAHL, and ProQuest using key terms related to fractures, occupational exposure, and risk. Eligible studies were screened, and key findings including risk factors, incidence rates, and effect sizes were systematically extracted and summarised.

Results:
Twenty-nine studies were included, with four studies reporting on recruits/trainees and 25 on qualified personnel. Recruit incidence ranged from 21.8 to 105.3 fractures per 1000 person-years, while the incidence in qualified personnel ranged from 1.9 to 57.6 fractures per 1000 person-years. Enlisted personnel, younger servicemembers (18–29 years), and personnel of the Army and Marine Corps branches were at increased risk. Traumatic fractures predominantly occurred in the lower extremities. Risk factors and mechanisms for traumatic fractures in military personnel included sports participation and physical training. Other common mechanisms included motor vehicle accidents and collisions, and (in combat settings) blasts from improvised explosive devices and gunshot wounds.

Conclusions:
Traumatic fractures are a substantial source of injury across military careers, not limited to initial training. Army and Marine Corps personnel face higher fracture risks, particularly in the lower limbs, with sports/physical training and combat-related risk factors associated with increased susceptibility.