Severe degeneration in the wrist of a rheumatoid patient remains a troublesome problem to handle. Concomitant upper extremity arthrosis, bilateral occurrence of wrist disease, and the need to maintain function for weight bearing and fine motor skills all factor into the surgeon's and patient's decision for surgical intervention. Total wrist arthrodesis with plate fixation remains an excellent choice for pain relief and for maintenance of the functional sphere provided by the upper extremity. Plate fixation adds the benefits of a decreased risk for complications and greater ease of wrist positioning for the surgeon. Other procedures, such as the Nalebuff and Feldon modified technique of intramedullary pinning, may be advantageous, however, in the case of a rheumatoid patient whose soft tissue envelope could lead to complications with plate fixation.
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