Attrition due to orthopedic reasons during combat training: rates, types of injuries, and comparison between infantry and noninfantry units.

PURPOSE: The purpose of this study is to identify the prevalence and types of orthopedic injuries in infantry and noninfantry units responsible for attrition from combat training. METHODS: 18,651 soldiers consecutively recruited to combat units (5 infantry and 4 noninfantry units) were included in this study. All recruited soldiers underwent and successfully passed a meticulous medical selection process. In all units, the soldiers participated in a suited fitness program that included marching, running, and strength training. Data were collected directly from attrite soldiers' files and detailed lists provided by the units' medical clinics. RESULTS: Out of 18,651 recruits, 641 (3.44%) attrite because of medical reasons. The leading cause of attrition was orthopedic diagnoses, and their overall rate was 43% (274 out of 641). Overuse injuries accounted for 90% of all orthopedic injuries. Low-back and lower extremity injuries accounted for 71.5% of all orthopedic injuries. There was high similarity in orthopedic injuries types and rates between infantry and noninfantry units. CONCLUSION: On the basis of our results, we recommend a multidisciplinary intense effort including physicians, physical training officers, physiotherapists, and commanders to significantly reduce overuse injuries, especially in the low-back and lower extremity regions.