title: 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.
authors.affiliation: Department of Orthopaedic Surgery Hyogo College of Medicine, Nishinomiya City, Hyogo, Japan.
authors.forename: Shigeo
authors.initials: S
authors.lastname: Fukunishi
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Fukui
authors.forename: Shoji
authors.initials: S
authors.lastname: Nishio
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Imamura
authors.forename: Shinichi
authors.initials: S
authors.lastname: Yoshiya