Palmar-Shelf Arthroplasty of the Wrist in Rheumatoid Arthritis

A REPORT OF NINE CASES

¹ Section of Orthopaedic Surgery, Yale University School of Medicine, New Haven, Connecticut 06510
² Stanford Medical Center, Palo Alto, California 94304

A technique of wrist arthroplasty has been described for instability in patients with rheumatoid arthritis. The procedure includes synovectomy of extensor tendons and the most severely involved joints, excision of the distal end of the ulna, excision of the radial styloid process with a sufficient amount of the distal end of the radius to relieve tension in the soft tissues, construction of a small anterior cortical shelf on the radius to prevent anterior displacement, repair of ruptured tendons, and loose closure of the dorsal capsular structures.

Of nine procedures performed, the results of six were rated good or excellent, three fair, and none poor. All wrists remained stable and motion was maintained. In two patients with fair results, persistent radial or ulnar deviation of the wrist prevented the attainment of maximum strength.

In our experience, most patients with instability of the wrist due to rheumatoid arthritis are candidates for the procedure.

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