Unusual distribution of multifocal stress fractures involving the upper and lower limbs in a military recruit demonstrated by bone scintigraphy

A 20-year-old man performed vigorous military training despite the presence of left thigh pain, and developed 11 stress fractures involving the upper (bilateral humeri and ulnas) and lower (both femurs, right tibia, left fourth metatarsal, and right calcaneus) extremities, which were demonstrated on bone scintigraphy (Zwas grade I-IV group). He had joined the army 4 months earlier. His military training involved running on the ground for 15 minutes and carrying a trench mortar daily every morning. Sometimes he carried out a forced march carrying arms, special training in mountainous areas, and played football. The plain radiographs of all suspected fractures showed various findings from normal to periosteal thickening.