Abstract
Aim To review the evidence supporting the British military policy that potential army recruits should have upper or lower limb metalwork removed before training.
Background British military policy requires that potential recruits with either upper or lower limb internal fixation metalwork fall below acceptable entry criteria. Military training introduces considerable new stresses upon individuals and this is not without risk. 25% of applicants fall below basic medical entry standards whilst many areas remain undermanned. The MoD has a duty of care as an employer towards recruits and established personnel.
Method A Medline literature search was conducted together with multinational correspondence from interested agencies to review the evidence for this policy.
Results Studies suggest that in the asymptomatic patient, metalwork should not be routinely removed. Recent literature suggests a 4–40% complication rate following removal of metalwork. Infection and refracture are among the common complications. Evidence in top-level athletes suggests only minimal problems relating to retained metalwork when returning to pre-injury performance levels.
Summary No evidence has been demonstrated to support current MoD policy, which appears to be historically based. Other nations often adopt a more lenient approach. Translating the evidence specifically to the “military” scenario would require further prospective study.
The abstracts were prepared by Secretary Mr K Trimble.
