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Female Aged 74 With Osteopenia Rheumatoid Arthritis Open Gustilo Grade II Tibial Fracture

Case Information: Female, age 74, rheumatoid arthritis treated with methotrexate, osteopenia with pronounced cortical thinning. Mechanical fall from less than standing height resulted in an open (Gustilo -Anderson II) tibial fracture, OTA/ AO 42-B3.

Fracture reduction was difficult due to poor bone quality. RUST scores at 6 and 12 weeks were 6 and 10.

On the 12-week X-rays and CT scan, callus formation was well underway, and the limb had achieved a virtual torsional rigidity score of VTR = 59% (fractured/intact), which indicates that significant structural healing had already taken place.


At 12 weeks the patient had no pain, reported outstanding health, and had regained full mobility. Given that rheumatoid arthritis is associated with a documented statistically significant increase in the risk of nonunion, and this elderly osteoporotic patient also had a compound wound and did not suspend the use of antimetabolite medication, this is an excellent result.