Radiolunate fusion in the rheumatoid wrist with Shapiro staples: clinical and radiological results of 22 cases.

Abstract

We performed a retrospective clinical and radiological case control study on 22 rheumatoid wrists following radiolunate fusion via Shapiro staples with a mean follow-up of 5 years. Radiographs showed one early loosening through dorsal staple migration and four nonunions. Six wrists fused in mild ulnopalmar dislocation of the lunate. Primary intra-articular positioning of a staple was found in nine wrists, secondary intra-articular staple dislocation was found in two wrists. Dorsal staple dislocation was found in four fused arthrodeses. Osteolysis around the staples was found in all but two wrists. In contrast to unsatisfactory radiological results the clinical results were good or excellent in 18 patients. Good and excellent clinical results in the majority of the patients following radiolunate fusion does not depend on the fixation device. Nevertheless staple fixation of the radiolunate joint in the rheumatoid wrist is associated with a high rate of radiological complications.