Radiolunate arthrodesis in rheumatoid wrist (21 cases)

Surgical radiolunate arthrodesis appears to be an appropriate procedure to stabilize ulnar translation of the carpus, to correct radial deviation of the wrist and consequently ulnar drift of the fingers and restore neutral orientation of the lunate when collapse occurs. From 1979 to 1988, radiolunate arthrodesis was performed on 21 unstable rheumatoid wrists with subluxation of the lunate (20 cases combined with an ulnar head resection and one case without). Average follow-up was 4 years and 1 month. Wrist collapse increased in 3 cases and remained stable in 6 cases (9 documented cases). When ulnar drift of the fingers is present (6 cases), the ulnar angulation of the third finger shows a 14-degree average improvement. Thirteen wrists were painfree, one presented a painful click, 4 patients were dissatisfied because of pain and recurrence of the disease. Three patients had died. Average ROM was 41 degrees in extension, 28 degrees in flexion, 8 degrees radial deviation and 23 degrees ulnar deviation. Grip, measureable in 9 wrists, showed improvement with an average range of 12,6 kg on right side and 9 kg on left side. Surgical procedure and complications are described.