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Arthrodesis of the wrist with intramedullary rod fixation is a simple technique that provides the opportunity for performing concomitant procedures. Iliac bone graft usually is not required with this technique, as the intramedullary rod is a load-sharing construct that allows compression at the fusion site and facilitates union. Rod removal usually is optional, and the long intramedullary beam effect of the rod can function as an internal splint if fibrous or hypoplastic union occurs. Early mobilization is possible, sometimes with only minimal splinting. The results with use of this technique over a ten year period of time in ten wrists (nine patients) with endstage radiocarpal joint instability are reported.

Resectional arthroplasty with interposition of a rolled tendon spacer was used to treat posttraumatic arthritis of the fifth metacarpal-hamate joint in eight patients. The average follow-up was 5 years. All of the patients subjectively rated the functional capability and the cosmetic appearance of their hands as good or excellent. After operation, there was a net increase of 30% in the average grip strength of the study group. The motion preserved at the small finger carpometacarpal joint facilitated power function of the hand.

Twelve patients with complex fractures of the distal radius were treated with the Orthofix external fixation system (EBI Medical Systems, Fairfield, NJ). On follow up physical examination, the average wrist dorsiflexion was 46 degrees, and the average volar flexion was 55 degrees. The average grip strength in the involved hand was 38 lb force. The average final radial angle was 18 degrees, and the average residual radial height was 12 mm. Average volar tilt was 3 degrees. The complication rate was 42%. Very rigid axial stability is afforded by the fixator, but the large 3.5 mm tapered bone screw diameter precludes redrilling for screw adjustment. The apparatus needs frequent monitoring to reconfirm the security of the locking nuts and cam mechanisms, and the Orthofix system can be reused only four times.

Thirty-three wrists in 25 patients with rheumatoid arthritis were followed for an average of 3.8 years after resection of the distal ulna. These patients, including those who had adjunctive implantation of a silicone rubber cap, manifested considerable amounts of carpal collapse, carpal translocation, rotational change of the wrist, and radial shift of the ulna. The progression of these complications was unpredictable. Four patients required revision. Three of these four patients had no articular contact between the lunate and radius on their preoperative x-ray film. Excision of less than 20 mm of the distal ulna is an acceptable range of resection. In 15% of the wrists, an osseous carpal stabilizer was seen on the preoperative x-ray film as a reliable radiographic indicator of radiocarpal stability. Another 12% of patients developed a bony carpal stabilizer during the postoperative period.