Problems in Rheumatoid Wrist Fusion

Two techniques have been developed to solve problems in performing fusion of the rheumatoid wrist. The benefits of fusion for the deformed, unstable and painful rheumatoid wrist are well established. Solid internal splintage should be provided at surgery to allow early hand mobilisation and avoid increased stiffness. This basic principle was first popularised by Mannerfelt (197 1). Additional reconstructive procedures may be carried out at the same time. Several methods of internal fixation are described. Clayton (1965) and Nicolle and Dickson (1979) use a Steinmann pin passed from the second or third metacarpal head, along the shaft and across the carpus into the radius. Millender and Nalebuff (1973) introduce the pin directly into the carpus between th