Article

In mutilans rheumatoid arthritis (RA) patients with major wrist destruction,
wrist arthrodesis is recommended. This type of arthrodesis needs carpal
reconstruction and stable fixation. The goal of this study was to assess the
functional and anatomical outcomes of an iliac crest graft and internal fixation
with two medullary pins. Six wrists in three patients suffering from RA were
reviewed clinically and radiologically at an average follow-up of 25 months. We
assessed the fusion of the iliac graft with the radius and the metacarpus, the
preoperative and postoperative carpal height, and the bone stock in front of the
thumb. All the patients had improved functionally. The iliac graft fused with the
radius in all cases and fused with the metacarpus in 5 out of 6 cases; the
non-union occurred in the wrist where only one pin was used. Restoration of
carpal height was associated with improvements in hand function. The bone stock
was sufficient to allow implantation of a trapezial cup during a total
arthroplasty of the thumb trapeziometacarpal (TMC) joint. No major complications
occurred. An iliac graft and two pins through the 2nd and 3rd metacarpals were
used to reconstruct the carpal height and to obtain wrist fusion. Internal
fixation with only one pin is not recommended. Functional improvement can be
attributed to the normal tension within the extrinsic flexors and extensors of
fingers and thumb being restored because the carpal height was restored. A
secondary TMC arthroplasty is theoretically possible.
CI - Copyright (c) 2014 Elsevier Masson SAS. All rights reserved.

Langue : ANGLAIS