Arthrodesis of the Wrist in Rheumatoid Arthritis: A Technique without External Fixation

Abstract

In advanced cases of rheumatoid arthritis with destruction, instability and pain the wrist joint needs to be arthrodesed. Long term periods of immobilization with plaster of Paris, following different methods of wrist-fusion, badly impair the total hand function. Arthrodesis of the wirst in rheumatoid arthritis should therefore preferably not require external fixation. This paper describes the development of such a procedure in a consecutive series of 124 wrist joint arthrodeses, two-thirds of which in rheumatoid arthritis. The technique is based on radio-carpal and intercarpal joint resection, excision of caput ulnae and fixation of the wrist joint from the 3rd metacarpal to high up in radius with a Rush pin. Compression is maintained by staples from radius to carpus locking of rotation. With this new technique 49 out of 124 arthrodeses are performed and the technique now is considered to be a standard procedure in rheumatoid arthritis. The technique is also tested in post-traumatic, neurological disorders as well as in congenital deformities.