オカザキ　ケン   Okazaki Ken   岡崎　賢    所属   医学部 医学科（東京女子医科大学病院）    職種   教授・基幹分野長
論文種別	症例報告
言語種別	英語
査読の有無	査読あり
表題	Stress Fractures in the Forefoot After Arthrodesis of the Hindfoot in a Patient with Rheumatoid Arthritis: A Case Report.
掲載誌名	正式名：Modern rheumatology case reports 略　 称：Mod Rheumatol Case Rep ISSNコード：24725625/24725625
掲載区分	国外
巻・号・頁	epub,pp.epub
著者・共著者	Yano Koichoro, Ikari Katsunori, Okazaki Ken
担当区分	最終著者
発行年月	2022/04
概要	Rheumatoid arthritis (RA) is an autoimmune disease that attacks multiple joints throughout the body. Ankle arthrodesis (AA) has been the gold standard surgery for end-stage ankle arthritis in patients with RA. Here, we report the case of a 67-year-old woman with RA who had displacement and loosening of total ankle arthroplasty (TAA). The ankle was converted to AA using a metal spacer and an intramedullary nail. The patient had no complications in perioperative terms of arthrodesis. However, multiple fractures were found in the metatarsal bones at the routine 3-year follow-up. Although the patient did not remember any symptoms, the clinical outcome deteriorated compared to that a year before. The hindfoot in this case report was fixed completely by an intramedullary nail, while the midfoot had already involved ankylosis because of severe joint destruction present before the surgery. As a result, the range of motion in the joints of the midfoot and hindfoot was lost, and it is probable that an excessive load was applied to the forefoot during push-off by the toes, resulting in a stress fracture. Patients with RA remain at risk of future progressive joint destruction in every joint of their body. Therefore, surgeons should choose a surgery that preserves ankle motion to decrease the rate of adjacent joint degeneration for severe ankle arthropathy in patients with RA.
DOI	10.1093/mrcr/rxac039
PMID	35460244