Spontaneous fractured neck of femur in rheumatoid arthritis: absence of radiographic changes on initial X-ray.

Spontaneous fractures have been documented in patients with osteoporosis and have been described in patients with rheumatoid arthritis. Two patients with rheumatoid arthritis who sustained femoral neck fractures in the absence of trauma are documented. Despite severe pain initial radiograph failed to demonstrate evidence of fracture, but subsequent radiographs later showed fractures in both cases. It is important in rheumatoid patients with continuing severe hip pain of sudden onset to suspect a stress fracture even if initial radiographs are normal.