“Stress” or “Fatigue” Fractures of Bone

“Stress” or “fatigue” fractures as a group appear to be very little known in this country. It is true that March-foot has become widely recognised and much reported since 1855, when Breithaupt1 was apparently the first to describe it, but until 1939 there do not appear to have been any examples recorded occurring in other bones. This is interesting, because ever since the first Great War, large numbers of cases have been encountered in recruits to the Finnish, Swedish, Norwegian, and German armies. There is evidently a curiously low incidence rate both in America and in Great Britain, for although I had been searching diligently since 1931, I had seen—until recent months—only fifteen examples, all in the upper third of the tibia and none (excepting March-foot) in any of the other bones in which the condition has been described. The normal incidence is further emphasised by the number of cases recent authors have been able to describe—for example, Professor Pfahler2, one example in the tibia; Mullard,3 one occurring in the neck of the femur; Jackson Burrows,4 two examples in the fibula; Weaver and Francisco,5 two in the tibia and one in the fibula. Contrast this with a single German author—Sheller6—who records 590 examples reported from the German Field Hospitals, 1935 to 1936, among which we may note 70 in the tibia, 13 in the femur, 12 in the fibula, 4 in the os calcis, and 3 in the pelvis.