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Considerations When Performing Arthrodesis in the Scleroderma Hand.

Chao Long¹, Jung Ho Gong², Scott D Lifchez³

¹Johns Hopkins University, Baltimore, MD, USA.

Hand (New York, N.Y.)

|September 15, 2021

Summary

This summary is machine-generated.

Arthrodesis is a safe surgical option for scleroderma hand deformities, even with disease-modifying antirheumatic drugs (DMARDs). This procedure offers a viable alternative to amputation, with a low complication rate and successful hardware removal.

Keywords:

anatomy arthrodesis diffuse cutaneous scleroderma hand joint contracture limited cutaneous scleroderma scleroderma

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Area of Science:

Orthopedic Surgery
Rheumatology
Hand Surgery

Background:

Scleroderma frequently causes hand deformities, leading to significant disability and impaired daily activities.
Digital contractures are a common manifestation of scleroderma, necessitating effective treatment strategies.

Purpose of the Study:

To evaluate the outcomes of arthrodesis in patients with scleroderma-induced digital contractures.
To assess the safety and efficacy of surgical joint fusion for treating hand deformities in scleroderma patients.

Main Methods:

Retrospective review of 9 patients (19 joints) who underwent arthrodesis for scleroderma hand deformities between 2015 and 2020.
Data collection included demographics, operative details, and postoperative complications such as wound dehiscence, ischemia, and infection.
Primary outcome was any postoperative complication, with a mean follow-up of 15.4 months.

Main Results:

A total of 19 joints were treated with arthrodesis in 9 female patients (mean age 55.3 years).
Most patients were on disease-modifying antirheumatic drugs (DMARDs); Kirschner wires (K-wires) were used in 18 joints.
The overall complication rate was 5.3% (1 of 19 joints), involving digital ischemia requiring amputation.

Conclusions:

Arthrodesis is a safe and effective procedure for the scleroderma hand, even in patients on DMARDs.
Uneventful K-wire removal in most cases supports their use, with a recommendation for nonpermanent placement due to hardware exposure risks.
Hand surgeons should consider arthrodesis as a treatment option for scleroderma hand deformities prior to considering amputation.