Limited arthrodesis for the rheumatoid wrist

Area of Science:

• Orthopedic Surgery
• Rheumatology
• Hand Surgery

Background:

• Rheumatoid arthritis frequently causes wrist instability, pain, and deformity, including ulnar shift and palmar subluxation of the carpus.
• Surgical intervention is often necessary to manage severe symptoms and improve function in affected wrists.

Purpose of the Study:

• To evaluate the efficacy of a combined surgical approach for unstable and painful rheumatoid wrists.
• To assess pain relief, functional improvement, and radiographic outcomes following the procedure.

Main Methods:

• A cohort of 25 patients with unstable rheumatoid wrists underwent limited arthrodesis, synovectomy, and a Darrach procedure.
• Follow-up averaged 3 years, with assessments including pain levels, range of motion, grip strength, and radiographic evaluation.

Main Results:

• The surgical intervention resulted in satisfactory outcomes, including significant pain relief, improved forearm rotation, and increased grip strength.
• A reduction in wrist extension and flexion was observed postoperatively (70% and 54% respectively).
• Radiographic deterioration of the lunocapitate joint was noted in 12 wrists, but these wrists remained stable and painless.

Conclusions:

• The combined surgical technique effectively manages pain and improves function in unstable rheumatoid wrists.
• Despite potential lunocapitate joint deterioration, the procedure offers a stable and painless wrist, enhancing quality of life for patients.