Young A, Kinsella P, Boland P
J Bone Joint Surg Br. 1981 Aug;63-B(2):239-43. doi: 10.1302/0301-620X.63B2.7217149.
Thirteen patients suffering from rheumatoid arthritis had 19 stress fractures of the tibia or fibula. These patients characteristically presented with sudden, severe, unexplained pain with localised tenderness just below the knee or above the ankle. In seven patients examination of the adjacent joint indicated a flare-up of disease activity or a pyogenic arthritis. In six patients the diagnosis was delayed by the late appearance of callus in minute fractures. All patients had rheumatoid deformities of the ipsilateral lower limb: valgus deformities of the knee and subtalar joints occurred most frequently. All patients had osteoporosis; all except two had received steroid treatment and five had abnormalities of calcium metabolism. We suggest that deformities of the knee and ankle predispose patients with rheumatoid arthritis and osteoporosis to stress fractures of the tibia and fibula.
13名类风湿关节炎患者发生了19例胫骨或腓骨应力性骨折。这些患者的典型表现为突发、严重、不明原因的疼痛，膝关节下方或踝关节上方有局部压痛。7例患者相邻关节检查显示疾病活动加剧或化脓性关节炎。6例患者因微小骨折中骨痂出现较晚而导致诊断延迟。所有患者同侧下肢均有类风湿畸形：膝关节和距下关节外翻畸形最为常见。所有患者均有骨质疏松；除2例患者外，其余患者均接受过类固醇治疗，5例患者有钙代谢异常。我们认为，膝关节和踝关节畸形使类风湿关节炎和骨质疏松患者易发生胫骨和腓骨应力性骨折。
