Total wrist arthrodesis with wrist fusion rod in patients with rheumatoid arthritis
Kenji Onuma, Ryosuke Shintani, Hisako Fujimaki, Koji Sukegawa, Tomonori Kenmoku, Kentaro Uchida, Naonobu Takahira, Masashi Takaso
Department of Orthopaedic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
Keywords: Rheumatoid arthritis; total wrist fusion; wrist fusion rod.
Objectives: This study aims to retrospectively review the short-term surgical outcome of wrist fusion using wrist fusion rod (WFR).
Patients and methods: Six wrists of four female patients (mean age 56 years; range 51 to 62 years) with advanced stage rheumatoid arthritis of Larsen IV or V were performed total wrist fusion using WFR. Clinical outcome was assessed using a numeric rating scale of pain satisfaction level. Bony fusion, correction of palmar subluxation and ulnar deviation, rod bending angle, wrist fusion angle, and complications were assessed from radiographs.
Results: All wrists achieved painless wrist stability with bony fusion of the radiocarpal joint. Both the palmar subluxation and ulnar deviation were corrected in all patients. Two radiographic complications were observed: rod fracture in one patient and a radiolucent line in proximal metacarpal bone in another patient. Both complications might have occurred as a result of instability of the third carpometacarpal joint, but neither influenced clinical outcome. Wrist fusion angle was smaller than rod bending angle at final observation.
Conclusion: Wrist fusion using WFR is an option for the treatment of advanced stage rheumatoid arthritis of wrist. According to our experience, the stability of third carpometacarpal joint should be assessed before surgery, and this joint should be fused if required. The bending angle of the intramedullary rod does not directly form the wrist fusion angle in contrast to the case with a dorsal wrist fusion plate.