Multiple pelvic insufficiency fractures in rheumatoid patients with mutilating changes

Abstract

Multiple insufficiency fractures occurred in two patients with mutilating rheumatoid arthritis (RA), leading to substantial disabilities. Both patients received long-term oral glucocorticoid therapy and underwent multiple lower-extremity surgeries such as total hip arthroplasty (THA) or Total knee arthroplasty (TKA). The multiple fractures were located in the pelvis and lumbosacral region. Fractures in both patients were treated conservatively. Although bony union and resumption of activities were achieved in one patient, the other patient was not able to resume ambulation. For RA patients with combined risk factors for insufficiency fractures, aggressive preventive intervention and careful clinical assessment for early detection and management are warranted.

Insufficiency fractures: A rare cause of foot and ankle pain in three patients with rheumatoid arthritis

“…Multiple fractures of the pelvis and lumbrosacral region were reported by Fukunishi et al. [17] . There are infrequent case reports in the medical literature describing insufficiency foot fractures in more than 1 bone in patients with RA.…”

Occipitosacral Fusion for Multiple Vertebral Fractures with Kyphotic Deformity in a Patient with Mutilating Rheumatoid Arthritis: A Case Report

“…This fracture was difficult to diagnose on even CT and MRI because of osteoporosis and beam-hardening artifact. [16][17][18] Thus, it is important to provide careful clinical assessment for early detection and management of this complication.…”

An Atraumatic Symphysiolysis with a Unilateral Injured Sacroiliac Joint in a Patient with Cushing’s Disease: A Loss of Pelvic Stability Related to Ligamentous Insufficiency?

“…GCs are well known to enhance the fracture risk by decreasing the number of osteoblasts and osteocytes, reducing osteoblastic function and production of extracellular matrix, and thus may lead to the loss of pelvic stability [ 22 , 25 – 31 ]. Hence, bone mass decreases and fracture risk increases [ 26 , 32 ].…”

“…There are few reports in the literature with comparable injury patterns and no history of trauma. These cases are documented in patients with rheumatoid arthritis and a long history of GC therapy or postmortem in CD patients [ 22 , 23 , 31 ].…”