Epidemiology of stress fractures among military cadets: a retrospective cohort study at a tertiary military medical center

Background: Stress fractures are a common overuse injury among physically active populations, yet data on their incidence and characteristics in military trainees remain limited. This study describes epidemiology, anatomical distribution, and management of stress fractures in military students at a tertiary military medical center. Methods: We performed a retrospective cohort review of 109 male military students diagnosed with stress fractures between January 2020 and August 2025. Demographics, risk factors, fracture sites, and treatment modalities were extracted from electronic medical records and imaging archives; tibial stress fractures were additionally graded using the Fredericson MRI system. Descriptive statistics, including means, standard deviations, frequencies and percentages, and inferential analyses such as chi-square tests, independent-samples t-tests and Mann–Whitney U tests, were conducted using SPSS version 25.0. Results: The mean age of the cohort was 19.68 ± 1.33 years; 76.1% were under 20 years of age. All fractures involved the lower part of the body, with the tibia most frequently affected (69.7%), followed by the femur (11.0%), foot (8.3%), and hip (8.3%). Anatomically, the right proximal tibia (13.8%) and left proximal tibia (11%) were the most common sites; bilateral injuries accounted for 12.9% of cases. Conservative management was undertaken in 70.6% of cases; 29.4% required surgical intervention, most commonly open reduction and internal fixation. Operative management was significantly associated with fracture location, with hip and femoral fractures more frequently treated surgically than tibial fractures χ 2 (5, N = 109) = 37.8, P < 0.001. Age and body mass index did not differ significantly between operatively and non-operatively managed patients. Conclusion: While conservative therapy suffices for most, nearly one-third of fractures required surgical stabilization. These findings support early imaging-based diagnosis, graduated training protocols, and targeted prevention strategies to reduce injury burden and maintain operational readiness.