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Journal of Bone and Joint Surgery - British Volume, Vol 89-B, Issue 12, 1620-1626.
doi: 10.1302/0301-620X.89B12.18880  
Copyright © 2007 by British Editorial Society of Bone and Joint Surgery
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Fusion of the wrist in rheumatoid arthritis

A CLINICAL AND FUNCTIONAL EVALUATION OF TWO SURGICAL TECHNIQUES

C. D. Toma, MD, Orthopaedic Surgeon1; P. Machacek, MD, Orthopaedic Surgeon2; P. Bitzan, MD, Orthopaedic Surgeon1; O. Assadian, MD, DTMH, Professor, Consultant Clinical Microbiology and Hygiene3; K. Trieb, MD, Associate Professor, Orthopaedic Surgeon4; and A. Wanivenhaus, MD, Orthopaedic Surgeon1

1 Department of Orthopaedic Surgery
2 Orthopädisches Spital Wien Speising, Speisinger Strasse, 109, 1130 Vienna, Austria.
3 Clinical Institute for Hygiene and Medical Microbiology, Medical University of Vienna, General Hospital Vienna, Waehringer Guertel 18-20, Vienna A-1090, Austria.
4 Department of Orthopaedic Surgery, Klinikum Kreuzschwestern Wels, Grieskirchnerstrasse, 42, A-4200 Wels, Austria.

Correspondence should be sent to Associate Professor K. Trieb; e-mail: klemens.trieb{at}klinikum-wels.at

We retrospectively compared wrist arthrodesis using the Mannerfelt technique in 19 or an AO-plate in 23 patients with long-standing rheumatoid arthritis. The mean follow-up was for 76 months.

Compared with the Mannerfelt fusion group, patients in the AO-plate group reported greater satisfaction with their wrist function (74% vs 37%, p = 0.015). Complications were reported in six wrists in the AO-plate group and two wrists in the Mannerfelt fusion group (p = 0.258). At final follow-up, 95% of patients (41) reported either no pain or only mild pain. There was improvement in flexion of the finger joints in both groups but no significant improvement in the extension lag in either group.

Both methods relieve pain and improve function. Overall, the activities of daily living scores and the patients’ subjective assessment of outcome tended to be higher in the AO-plate group than in the Mannerfelt fusion group, although the difference was not statistically significant. Similarly, although more postoperative complications occurred in the AO-plate group, the difference between the two groups was not statistically significant.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General