The Journal of Bone and Joint Surgery, Vol 71, Issue 2 223-227, Copyright © 1989 by Journal of Bone and Joint Surgery, Inc
Palmar shelf arthroplasty in the rheumatoid wrist. Results of long-term follow-up
H Gellman, G Rankin, R Brumfield, D Chandler and B Williams
University of Southern California, Department of Orthopaedic Surgery, Rancho Los Amigos Medical Center, Downey 90240.
Sixty-three palmar-shelf arthroplasties (so-called pseudofusions of the
wrist) that had been performed between 1970 and 1978 in forty-nine patients
were evaluated. The length of follow-up averaged eighty-three months
(minimum, twelve months for the wrists that fused and twenty-four months
for those that did not). Preoperatively, all wrists were painful, with 96
per cent being moderately or severely so. Carpal subluxation was present in
79 per cent of the wrists. Postoperatively, pain recurred in 84 per cent of
the wrists, but it was less severe (mild in 48 per cent, moderate in 35 per
cent, and severe in 2 per cent). Sixty-eight per cent of the wrists fused
spontaneously and were no longer painful. Of the twenty wrists (32 per
cent) that did not fuse, 70 per cent were mildly or moderately painful. In
patients who have rheumatoid arthritis, we found that palmar shelf
arthroplasty was followed by a high rate of delayed spontaneous fusion and
an unacceptably high rate of recurrent pain, although the pain was less
severe.
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