Total Wrist Fusion and Limited Wrist Fusion Procedures in Rheumatoid Arthritis

Abstract

The wrist is a “keystone” of hand function (Clayton, J Bone Joint Surg 47A:741–750, 1965). Pain-free stability of the wrist is a prerequisite for the rheumatoid wrist to maintain power and perform various manual tasks. To prevent wrist deterioration, tight medical control of disease activity is essential. Severe extensor tenosynovitis, dorsal subluxation of the ulnar head, carpal supination, and dislocated ECU tendon were associated with finger extensor tendon ruptures. Synovectomy of the extensor tendons and the wrist joint combined with Darrach procedure was recommended for the treatment of painful rheumatoid wrist. Clinical results were satisfactory, but over time, ulnar shift and palmar subluxation of the carpus with progressive deterioration could occur. For the moderately deteriorated wrist, limited wrist radiolunate (RL), radioscapholunate (RSL), and radiolunotriquetral (RLT) fusion provides pain relief, stability, and some motion through the midcarpal joint. In the wrist, in which both the radiocarpal and the midcarpal joints were damaged, midcarpal arthroplasty using a tendon ball combined with limited wrist fusion at the radiocarpal was one of the options for wrist reconstruction. For the highly deteriorated wrist with dislocation, total wrist fusion using an intramedullary wrist fusion rod (WFR) fixation is the most reliable procedure to provide long-lasting pain relief and stability with gain in grip power.