[Radiographic course of 39 rheumatoid wrists after synovectomy and stabilization]

Between 1984 and 1995, 39 patients underwent wrist synovectomy-stabilisation. Among these patients, 5 had died and 2 could not rectum for review. These 7 patients were excluded from the study. 32 patients were therefore included in the study. These patients had an average age of 50 years, with an average follow-up of 65 months. We used the Larsen classification to assess wrist osteo-articular involvement. To evaluate carpal instability, we measured: the carpal height with the Mac Murtry index, Shapiro's angle and the modified Shapiro's angle (the angle between the radial diaphysis and the second metacarpal diaphysis), the angle of finger ulnar deviation, the carpal ulnar deviation with the ulnar deviation index of the carpus, the radial deviation with the radial deviation index of the carpus, the carpal frontal dislocation. Carpitis continued to develop and Larsen's grade deteriorated in 50% wrists despite surgery. The average value of the radial sliding index of the carpus increased from 0.11 to 0.15: this showed an average ulnar sliding of 2.2 mm. The average Shapiro's angle increased from 118.2 degrees to 125 degrees. At follow-up, we observed anterior translation of the carpal bones and an increased distance between the proximal and distal carpal rows. The distance between the proximal and distal rows of the carpus appeared to be corrected by extensive synovectomy. Radio-carpal and mid-carpal synovectomy increased the carpal ulnar sliding. The modified Shapiro's angle was corrected by transfer of the extensor carpi radialis longus onto the extensor carpi radialis brevis. In contrast with other operations without stabilisation, the Sauvé-Kapandji procedure limited ulnar sliding and radial tilting of the carpus. Stabilisation of the carpus therefore participates in control of ulnar deviation of the long fingers. Transfer of the extensor carpi radialis longus onto the extensor carpi radialis brevis seems effective on wrist relaxation, by medialization of the traction force of the extensor carpi radialis longus. Our results with of Larsen stage IV were encouraging. The indication for wrist arthrodesis could be limited to stage IV with radio-carpal dislocation or stage V.