Unusual distribution and onset of stress fractures in soldiers.

Ninety-four stress fractures were detected in 64 soldiers by scintigraphy during the first 11 weeks of basic training. Unlike past military studies that showed large numbers of stress fractures of the feet, only 2% were in the metatarsals and none were in the calcaneus. Most fractures were in the tibia (71%) and femoral shaft (25%). Contrary to previous reports in the literature, the fractures occurred later in training, with 67% occurring during the fifth to eighth weeks of basic training and 12 percent during the ninth to eleventh weeks. This unusual distribution and onset has possible explanations in (1) new training concepts to fit modern warfare, with more emphasis on runs and marches; (2) new apparel and equipment carried by the soldiers; (3) changes in prearmy lifestyle; and (4) the extensive use of bone scan for diagnosis.

Various approaches to burn care in the Lebanon War, 1982.

All soldiers severely burned during the Lebanon War, 1982, were hospitalized in one of four facilities, in each of which different methods of burn care are practiced. These methods represent the various approaches to burn care in different centers in the world and in the literature. Resuscitation was adequate in all facilities. Oral hyperalimentation, although administered in different ways, is recognized as a main factor in preventing infections and enhancing healing in burn victims. The main aspect in which opinions differ is the care of the wound itself. However, it was clear after examining many of the patients from the different centers that tangential excision is superior to delayed excision, and certainly to conservative treatment. The difficulties in comparing different methods of treatment are discussed. Early and continuous psychological surveillance is necessary for the successful recovery and rehabilitation of burn patients; a special teamwork model was developed to promote this approach.

Subtalar dislocations.

Severe plantarflexion of the foot associated with adduction and supination resulted in medial subtalar dislocation in three patients. Closed manipulation in two patients and open reduction in one restored normal anatomy of the foot, with no complications in a follow-up of 1 to 2 years.