NHS Grampian, Aberdeen, UK
Aberdeen Royal Infirmary, Aberdeen, UK.
BMJ Case Rep. 2024 Jan 30;17(1):e254840. doi: 10.1136/bcr-2023-254840.
Stress fractures are often associated to activities that requires repetitive stress such as running. However, insufficiency-type stress fractures can also occur in patients with risk factors such as rheumatoid arthritis. Diagnosis of stress fracture would require a thorough clinical evaluation along with radiological imaging. However, this may be difficult due to how it mimics other musculoskeletal problems. The case of a woman in her 60s presenting with 2 months of severe ipsilateral right knee and ankle pain is used as an example. Based on initial clinical assessment and plain radiograph, her provisional diagnosis was osteoarthritis or inflammatory arthritis secondary to rheumatoid disease. However, MRI scan revealed that she had multifocal stress fractures in her knee, ankle and foot. Hence, we hope that this case study can allow clinicians to consider multifocal stress fracture as a possible diagnosis in patients with risk factors and to have lower threshold in performing MRI scans.
应力性骨折通常与需要重复应力的活动有关，如跑步。然而，患有类风湿关节炎等危险因素的患者也可能发生疲劳性应力性骨折。应力性骨折的诊断需要彻底的临床评估和影像学检查。然而，由于它模仿其他肌肉骨骼问题，这可能会很困难。我们使用一位 60 多岁女性的病例来说明，她出现了 2 个月的严重同侧右膝和踝关节疼痛。根据初步的临床评估和普通 X 线片，她的初步诊断为骨关节炎或类风湿疾病引起的炎症性关节炎。然而，MRI 扫描显示她的膝盖、脚踝和脚有多发性应力性骨折。因此，我们希望本病例研究可以让临床医生在有危险因素的患者中考虑多发性应力性骨折作为可能的诊断，并降低进行 MRI 扫描的门槛。
