Radiolunate, radioscapholunate and total wrist arthrodesis in rheumatoid wrist instability

Rheumatoid destruction of the ligaments of the wrist leads to ulnopalmar instability. High instability with less joint destruction causes radiocarpal subluxation, while progressive joint destruction with minimal instability leads to radiocarpal ancylosis, which may stabilize the wrist. Based on these findings radiolunate and radioscapholunate arthrodesis have been performed since the 1980s. These procedures allow sufficient correction of the ulnopalmar subluxation by saving some range of motion. Increase of joint destruction depends on the accuracy of the synovialectomy and the activity of the disease. Differential indication for radiolunate, radioscapholunate and total wrist arthrodesis depends on the osteochondral and ligamental destruction of the wrist. The aims of treatment are stabilization of the wrist and preserving as much range of motion as possible. Partial or total wrist arthrodesis is associated with a high fusion rate and is well tolerated by patients with a high satisfaction rating.