Arthrodesis of the wrist in rheumatoid arthritis. A follow-up study of 62 cases.

Abstract

Two cases of pseudarthrosis of the total of 62 wrists are reported. The motion of the first, fourth and fifth C-MC joints has practical value after "subtotal" wrist arthrodesis in rheumatoid patients. The frequent non-union of the joints between the trapezium/scaphoid and around the os triquetrum was painless and without clinical significance. If the wrist was fused in a neutral position (41 wrists) the position of the index finger was increased more than five degrees in the ulnar direction at follow-up in nine hands (22%). In no single case was the change in the deviation more than five degrees in the radial direction. If the wrist was fused in the radial position more than five degrees (five cases), the change in the deviation of the index finger was correspondingly ulnar in every case. If the wrist was fused over five degrees in the ulnar position (12 cases), in four cases the index finger deviated more than five but ten degrees or less in the radial direction at follow-up compared with the position before the arthrodesis. The wrist was 15 degrees or more in the ulnar direction in each of these four cases at follow-up. The position of the wrist should be in only slight ulnar deviation, less than 10 degrees, when the angle between the radius and the second metacarpal bone is measured. Either slight dorsal flexion or the zero position are recommended.