Rheumatoid arthritis of the wrist presents a dilemma:
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This senior woman presented with wrist swelling. She had been previously managed elsewhere with a Swanson flexible wrist arthroplasty, complicated by infection, which was treated with implant removal. She had done well for the last four years, but recently had swelling and tenderness of the wrist. Xrays showed a flail wrist with radiometacarpal impingement: |
She was treated with splinting, and responded well. However, she returned four months later with a draining sinus from the distal ulna and evidence of osteomyelitis. |
She was treated with radical resection of the infected bone. Intraoperative cultures grew out normal skin flora and she received 6 weeks of appropriate intravenous antibiotics. |
There was no cinical evidence of residual infection. She maintained a functional range of motion from her pseudoarthrosis and did not wish to have any more surgery. |
Four years later, she complained of wrist instability, and xrays confirmed intermittent radiometacarpal dislocation. |
She was treated with wrist arthodesis, using a sculpted fresh frozen femoral head allograft and a cerclage reinforced plate and screw fixation. |
Late result, showing graft incorporation and remodelling. |
Search for... Swanson Wrist Arthroplasty Femoral Head Allograft Rheumatoid Wrist Arthroplasty
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