Risk stratification scoring system for femoral neck bony stress injuries in military recruits: a pilot study

Key Points

1. The Hip1 Scoring Tool is a tool with 13 clinical markers that classifies clients as “high risk” if they score ≥ 5 and "low risk" if they score ≤ 4.

All key points available for members only

Start free trial

Or log in here

BACKGROUND & OBJECTIVE

Bony stress injuries (BSI) are overuse injuries resulting from excessive repetitive loading on otherwise healthy bone, and they frequently affect military recruits during the initial months of training. These injuries occur along a pathophysiological continuum, beginning as a stress reaction and potentially progressing to a complete fracture if the accumulation of microdamage surpasses the bone's capacity for remodeling and repair.

Injuries involving the femoral neck and pelvis are of particular concern. Specifically, "tension-side" BSIs in the femoral neck are considered high-risk due to their propensity for fracture propagation, non-union, and the potential to terminate a recruit's military career (1,2).
A critical need exists for preemptive screening to improve diagnostic efficiency and minimize unnecessary imaging, as femoral fractures are often diagnosed on imaging (1,2).

To address these challenges, clinicians at the Commando Training Centre Royal Marines (CTCRM) developed the 'Hip1' tool, a clinical risk assessment system informed by expert knowledge and standard presenting features (see figure 1).

Although the Hip1 tool has been used locally, its diagnostic utility, sensitivity, and specificity had not been formally evaluated before this study. This paper presents a pilot study to assess the tool's effectiveness in stratifying risk and allocating medical resources to recruits most in need.

Bony stress injuries are overuse injuries resulting from excessive repetitive loading on otherwise healthy bone, and they frequently affect military recruits during the initial months of training.

The Hip1 tool offers a simple, structured clinical scoring system that doctors and physiotherapists can use to standardize the initial evaluation of atraumatic hip, groin, and pelvic pain in a training environment.

METHODS

A retrospective cohort study for diagnostic utility at the CTCRM.

Start free trial

to unlock full access to this review and 1229 more

Or log in here