Injury. 2025 Nov 26;57(2):112911. doi: 10.1016/j.injury.2025.112911. Online ahead of print.

OBJECTIVE: Distal femur shaft fractures are typically associated with high-energy trauma. Stress fractures involving the distal femur shaft are extremely limited. Therefore, epidemiological characteristics, diagnostic protocol, optimal management strategies, and prognosis of distal femoral shaft stress fractures (DFSSF) remain poorly understood. This study aims to report clinical experience with 10 cases of DFSSF in South Korean military.

METHODS: This retrospective case series included patients diagnosed with DFSSF at the single South Korean military hospital between January 2022 and December 2023. Demographic and epidemiologic data, including military rank and training context, were collected. Radiographic evaluation including AO classification and femoral bowing angles were assessed. Clinical outcomes assessed included time to union, treatment modality, return to military duty, and complications.

RESULTS: Nine patients were male, one female noncommissioned officer candidate with a mean age of 21.2 ± 1.8 years (range, 19-24). As military rank, six patients were recruits, two were privates, and one patient was a private first class. The mean anterior and lateral femoral bowing angle measured by the Sasaki method was 3.7 ± 1.8° and 12.7 ± 2.3° respectively. All fractures achieved successful union within an average of 16.3 ± 2.4 weeks. All patients successfully returned to full military duty at an average of 16.7 ± 2.8 weeks post-injury. No complications were observed.

CONCLUSION: This study provides valuable insight into the rare entity of DFSSF, emphasizing clinical awareness, and optimal management strategies.

LEVEL OF EVIDENCE: Case Series, IV.

PubMed:41344100 | DOI:10.1016/j.injury.2025.112911