title: Attrition due to orthopedic reasons during combat training: rates, types of injuries, and comparison between infantry and noninfantry units.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Institute of Military Medical Research, Sheba Medical Center, 2 Sheba Road, Ramat Gan, 5266202, Israel.
authors.forename: Oren
authors.initials: O
authors.lastname: Schwartz
authors.affiliation: Institute of Military Medical Research, Sheba Medical Center, 2 Sheba Road, Ramat Gan, 5266202, Israel.
authors.forename: Tal
authors.initials: T
authors.lastname: Levinson
authors.affiliation: Dermatology and STD Department, Sheba Medical Center, 2 Sheba Road, Ramat Gan, 5266202, Israel.
authors.forename: Nadav
authors.initials: N
authors.lastname: Astman
authors.affiliation: Israeli Ministry of Health, 39 Yrmiyahu Street, Jerusalem, 9101002, Israel.
authors.forename: Lavon
authors.initials: L
authors.lastname: Haim
mesh_terms: D001134:Arm Injuries / Q000453:epidemiology; D019567:Back Injuries / Q000453:epidemiology*; D012090:Cumulative Trauma Disorders / Q000453:epidemiology*; D006230:Hand Injuries / Q000453:epidemiology; D006801:Humans; D007557:Israel; D007869:Leg Injuries / Q000453:epidemiology*; D008889:Military Personnel / Q000145:classification / Q000706:statistics & numerical data*; D064797:Physical Conditioning, Human / Q000009:adverse effects*; D015995:Prevalence; D055070:Resistance Training / Q000009:adverse effects; D012420:Running / Q000293:injuries