J Korean Soc Surg Hand.  2013 Dec;18(4):196-205. 10.12790/jkssh.2013.18.4.196.

Current Concept of Surgical Management for Rheumatoid Arthritis of the Wrist

• Woo SJ
• Park MJ

• KMID: 1840503
• DOI: http://doi.org/10.12790/jkssh.2013.18.4.196

Abstract

Rheumatoid arthritis is a systemic inflammatory disorder inducing multiple joint destruction. The wrist joint is frequently involved in early stage and proper management can preserve the ability to maintain a daily living and to work. Advances in medical treatment modalities can halt most joint destruction, however, not in all instances of joint inflammation and deformities. Most patients want to improve their own functional disability, pain, aesthetic problems in addition to medication. We review the current concept of rheumatoid wrist surgery and discuss the surgical treatment strategies for optimizing outcomes for patients with rheumatoid wrist.

Keyword

Rheumatoid arthritis; Wrist; Surgical treatment

MeSH Terms

Arthritis, Rheumatoid*
Congenital Abnormalities
Humans
Inflammation
Joints
Wrist Joint
Wrist*

Figure

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  Fig. 1. (A) Arthroscopic synovectomy of the wrist rheumatoid arthritis. (B) Intraoperative arthroscopic photographs demonstrating diffuse synovectomy of the wrist joint, and (C) subsequent removal of the synovium.

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  Fig. 2. (A) Intraoperative photographs demonstrating extensive extensor tenosynovitis with synovitis and (B) subsequent open synovectomy of the dorsal wrist joint.

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  Fig. 3. (A) Postoperative X-ray of Darrach procedure, (B) matched resection arthroplasty, and (C) hemiresection interposition arthroplasty.

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  Fig. 4. (A) Sauvé-Kapandji procedure. (B) An asterix indicate a compression screw for the distal radioulnar joint arthrodesis, and white arrow and black arrow demonstrate pseudoarthrosis and extensor carpi ulnaris tenodesis, respectively.

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  Fig. 5. Radiocarpal partial arthrodesis in rheumatoid wrist. (A) Preopertative and (B) postoperative radiographs.

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