Rheumatoid Wrist Reconstruction
This chapter presents a case scenario of a 55-year-old woman with a history of rheumatoid arthritis (RA) who is seen with progressive deformity in her wrists and hands. The distal ulna is commonly dorsally prominent in RA due to incompetent ligamentous stabilizers of the distal radioulnar joint (DRUJ) and volar extensor carpi ulnaris subluxation, causing carpal supination and a caput ulna deformity. Treatment of DRUJ pathology with resection arthroplasty relies upon local tissue stabilization to prevent symptomatic radioulnar impingement. In patients with RA at both the radiocarpal and midcarpal joints, total wrist arthrodesis and wrist arthroplasty are viable surgical options to alleviate pain. In patients without midcarpal arthritis, partial wrist arthrodesis provides reliable long-term outcomes with improved pain and patient satisfaction while maintaining wrist range of motion and improving grip strength. The chapter provides recommendations for implementing evidence-based practice in the clinical setting.
