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OBJECTIVE: Pain reduction in the affected proximal interphalangeal joint (PIP joint) by synovectomy, loose body extraction, dorsal arthrolysis. INDICATIONS: Therapy-resistant synovitis in rheumatoid arthritis (RA), early stage primary and secondary degenerative arthritis, loose bodies, capsular contracture. CONTRAINDICATIONS: Established biomechanic changes in RA (boutonniere and swanneck deformity). Large dorsal synovial cysts. Advanced radiologic changes in degenerative arthritis. Joint instability. Fresh skin lesion near portals. SURGICAL TECHNIQUE: Vertical traction of the affected finger in a Chinese finger trap if arthroscopy of a metacarpophalangeal joint is also planned, otherwise the joint can be placed on a hand table. Fill joint with Ringer solution. A radial and ulnar dorsal portal is created at joint space level, between the lateral band of the extensor tendon and the collateral ligament. Diagnostic arthroscopy. With insufficient visibility, "blind" shaving in dorsal recess. Completion of synovectomy under vision; 1.9 mm arthroscope with 30° angle of vision; 2.0 mm shaver (aggressive cutter). Closure of portals. Soft padded dressing. POSTOPERATIVE MANAGEMENT: Immediate postoperative mobilization for full range of finger movement. RESULTS: From 2009-2011, 91% of the patients treated with arthroscopic PIP joint synovectomy interviewed by telephone about pain reduction and satisfaction with the operation. Half of the 22 patients had RA and the other half degenerative arthritis, each with 14 joints treated. In all, 9 RA patients (11 treated joints, 79%) and only 1 patient with degenerative arthritis (2 treated joints, 14%) were content. The procedure achieves good pain reduction and functional improvement of the hand in RA. It can however not be recommended for degenerative arthritis except in selected cases.

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BACKGROUND: Operative treatment of chondrocalcinosis (calcium pyrophosphate dihydrate deposition disease=CPPD disease) of the wrist is hardly ever mentioned in the literature. Since the chronic, recurrent type of this disease resembles rheumatoid arthritis (RA) as well as osteoarthritis, the author has performed arthroscopic synovectomy of the wrist, which achieves excellent results in RA und offers high patient comfort as an atraumatic procedure with low morbidity. This article presents the experience made with arthroscopic synovectomy in CPPD disease of the wrist. PATIENTS AND METHODS: Out of 74 arthroscopic synovectomies in 71 patients with symptomatic CPPD disease of the wrist, 46 operations in 43 patients were followed for an average of 26.6 months after surgery. 15 women and 28 men at an average age of 64.5 (42-90) years had a telephone interview and were asked for pain, functional impairment and satisfaction with the intervention. Intraoperative and histologic findings were recorded. According to the Romano Classification, there was SCAC (scaphoid chondrocalcinosis advanced collapse) I in 6 cases (13%), SCAC II in 18 (39%), SCAC III in 9 (19.5%) and SCAC IV in 3 cases (6.5%). In 10 X-rays, classification according to Romano was not possible. RESULTS: There was a significant reduction in pain at rest and on weight-bearing as well as a significant improvement in hand function. 74% of patients would chose to undergo the intervention again. Arthroscopy revealed the typical symptoms of CPPD disease in all cases. In 38 out of the 46 operations, a histologic examination was performed and was positive in 20 cases. CONCLUSIONS: Arthroscopic synovectomy of the wrist in patients with CPPD disease provides high patient satisfaction regardless of the radiologic stage. The procedure is atraumatic with low morbidity and high patient comfort. The Romano Classification should be supplemented by an additional early stage, SCAC 0. More often than suspected, CPPD disease may be responsible for wrist pain of unknown origin even in middle-aged patients.

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OBJECTIVE: Pain relief and improvement of hand function by ganglion cyst resection and/or creation of a dorsal capsular window with partial synovectomy. In the case of visible ganglion cysts consideration of aesthetic aspects. INDICATIONS: Visible and occult persisting dorsal wrist ganglion cysts, recurrent ganglion cyst after open or arthroscopic resection and intraosseous ganglion cyst with an extraosseous portion. CONTRAINDICATIONS: Recent skin lesion of the wrist. SURGICAL TECHNIQUE: Standard setting for wrist arthroscopy. Portals: radiocarpal 3­4 and 6R, midcarpal radial (RMC) and midcarpal ulnar (UMC) portals. Start with arthroscopy in 3­4 portal. If there is insufficient visualization of the dorsal capsular fold, change the arthroscope to the 6R portal. From here a tangential view onto the dorsal capsule at the level of the scapholunate (SL) ligament can be obtained. If a large ganglion overlying the 3­4 portal or the RMC portal is present, UMC portals are primarily used. Intra-articular visualization of ganglion structures should always be attempted, especially for occult ganglion cysts. If the radiocarpal findings are inconspicuous, midcarpal arthroscopy from the UMC portal is performed to visualize the dorsal capsule at the SL ligament. Depending on the main localization of the visible alterations, ganglion or thickening of the capsule, a dorsal capsular window is created at the level of the SL ligament either radiocarpal or midcarpal or overlying both joints. Complete resection of the ganglion is controlled by palpation. Use of a 2.4 mm arthroscope with 30° angle of vision and 2.5 mm shaver (aggressive cutter). Low-suction drainage and soft padded dressing. An arthroscope with 70° angle of vision enables an even better view onto the dorsal capsule. POSTOPERATIVE MANAGEMENT: Immediate wrist mobilization, avoidance of excessive loading for 3 weeks. Physiotherapy is necessary if wrist flexion is not regained 3  weeks postoperatively. RESULTS: From 2007 to 2010 a total of 92 wrists from 88 patients were treated by arthroscopic ganglion cyst resection, 44 % for occult and 17 % for recurrent ganglia. At a mean follow-up of 78 % after 29.5 months a high patient satisfaction of 90 % was achieved. The only complication was a complex regional pain syndrome (CRPS) in one patient. The recurrence rate was 12.5 %.

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OBJECTIVE: Pain reduction in the affected metacarpophalangeal joint (MP joint) by synovectomy, loose body extraction and resection of intraarticular scars. INDICATIONS: Synovitis in rheumatoid arthritis (RA) not responding to antirheumatic treatment, primary and secondary degenerative arthritis, osteochondral lesions, loose bodies, foreign bodies, capsular contracture, septic arthritis, posttraumatic arthralgia (old collateral ligament injury), intraarticular fractures. CONTRAINDICATIONS: Established biomechanical changes in RA such as ulnar deviation and palmar subluxation with extensor tendon luxation of the MP joint. Advanced radiologic changes in degenerative arthritis. Joint instability in posttraumatic conditions. Fresh skin lesion near portals. SURGICAL TECHNIQUE: Longitudinal traction of the affected finger in a Chinese finger trap. The joint is filled with Ringer solution. Placement of a radial and ulnar dorsal portal at joint space level, through the extensor hood, at the dorsal border of the collateral ligaments. Diagnostic arthroscopy. In case of insufficient visibility (i.e., bulky synovitis in RA) "blind" shaving in the dorsal recess at first. Completion of synovectomy under sight. If necessary additional ablation of synovial tissue by a radiofrequency (RF) electrosurgical system. Use of arthroscope (1.9 mm) with a 30° angle of vision and shaver (aggressive cutter; 2.0 mm). Low-suction drain, soft padded dressing. POSTOPERATIVE MANAGEMENT: Immediate postoperative mobilization for the full range of finger movement. RESULTS: In 106 MP joint arthroscopies from 2009-2011, very high patient satisfaction was achieved. Best results were obtained in RA, even in advanced radiologic changes (Larsen stages 1-3). Only in Larsen stage 4 results were rated lower. In early stages of degenerative arthritis (Kellgren-Lawrence 0-2), patient satisfaction was also very high, however decreased rapidly with increasing degree of radiologic changes. The results in posttraumatic cases are promising.

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In arthroscopic wrist surgery, the resection of dorsal wrist ganglia has become a well accepted practice. As advantages for the minimally invasive procedure the low complication rate and low postoperative morbidity, less postoperative pain and faster recovery over open techniques are discussed. The possibility to assess accompanying joint pathology is considered as another advantage. The importance of identifying a so-called ganglion cyst stalk seems to have been overstated. Regarding the technique, the main discussion points are the size and localisation of the capsular window and the necessity of additional midcarpal arthroscopy. The possibility and results of treatment of recurrent ganglion cysts are still controversial. Our own experience and that of some authors are positive. Hardly mentioned in the literature is the treatment of occult dorsal wrist ganglia and its results, which is considered as very successful by the authors.

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With the advancements in arthroscopic technique, arthroscopy has become feasible in most human joints, even those as small as the finger joints. The metacarpophalangeal joints are very well suited for arthroscopy and arthroscopic therapy. Good results have been reported on arthroscopic synovectomy of the metacarpophalangeal joints in rheumatoid arthritis. Osteochondral lesions in degenerative arthritis, loose bodies and foreign bodies can well be treated. Arthroscopic arthrolysis for capsular contracture and treatment of post-traumatic lesions have been performed successfully. The arthroscopic assistance in the treatment of intraarticular fractures and the capsular shrinkage for instability have been described. However, metacarpophalangeal joint arthroscopy has not been popularised up to now and its role in clinical practice remains to be established. Existing indications will be discussed with respect to our own experience.

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AIM: The aim of this study was to make a mid-term evaluation of an unconstrained pyrocarbon prosthesis (Ascension®) in the treatment of idiopathic degenerative arthritis of the proximal interphalangeal joint of the hand. METHOD: 13 implants (10 patients) were clinically and radiologically studied after a follow-up period of 71 months (range: 48-92 months). RESULTS: The average ROM was 52° (± 27°STD). A luxation of the components did not occur and all implants are still in-situ. However, X-ray examination was unremarkable in only six fingers. In seven patients significant radiolucent lines (≥ 1 mm) were detected. Three prosthesis demonstrated axial subsidence and in one patient a loosening of the proximal component with axial rotation was observed. CONCLUSION: The results of this study show a high complication rate after an average of 6 years after implantation. Radiolucent lines in half of the cases may be explained by a lack of osteointegration of the prosthesis. The average ROM differs significantly from patient to patient, which has to be taken into account when discussing different treatment options.

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OBJECTIVE: Correction of swan neck deformity at the PIP and DIP joint by reconstruction of the oblique retinacular ligament through palmar transposition of one distally pedicled lateral band (oblique retinacular ligament reconstruction (ORL) = Littler II). INDICATIONS: Rheumatoid swan neck deformity Nalebuff stages I-III (dynamic, partially contracted, contracted). The swan neck deformity should be of articular origin. CONTRAINDICATIONS: Advanced radiologic changes of the PIP joint (Larsen 3-4) [12]. Extrinsic and intrinsic causes of swan neck deformity. Flexor tendon synovitis. SURGICAL TECHNIQUE: Dorsal approach to the PIP joint. One lateral band is sectioned proximally at the level of the musculotendinous junction. It is then isolated from the extensor apparatus and left pedicled distal at the insertion. The isolated lateral band is then passed underneath the Cleland ligament from distal to proximal and is sutured to the distal edge of the A2 pulley. The correct tension of the tenodesis achieves flexion at the PIP joint and extension at the DIP joint. In contracted and partially contracted joints, the PIP joint is temporarily transfixed. Depending on the clinical findings, a synovectomy or dorsal arthrolysis of the PIP joint must be performed. POSTOPERATIVE MANAGEMENT: Immediate postoperative mobilization of the PIP joint for flexion. A figure-of-eight finger splint has to be worn for 12 weeks. The splint must allow full PIP flexion and limit extension over 20-30° of flexion. In case of temporary transfixation of the PIP joint, wire removal after 4-6 weeks and start of mobilization. Passive extension over 20-30° of flexion only after 12 weeks. RESULTS: From 2004-2007, 30 PIP joints in 20 rheumatoid patients were treated for swan neck deformity. In all cases, the original method as described by Littler was used. A change of the procedure due to insufficiency of the Cleland ligament or the A2 pulley was not necessary in any of the cases. After a mean of 22 months, 26 PIP joints in 17 patients could be followed up. In 12 PIP joints, the deformity was partially contracted, in two joints contracted. In 10 joints, a dorsal arthrolysis had to be performed, while a lengthening of the medial band was performed in 1 patient. The swan neck deformity could be compensated in all cases. Preoperative hyperextension of a mean 21° could be reduced to a mean 24° of flexion postoperatively. The ROM did not change much but was shifted from the extension sector to the flexion sector of the PIP joint. In no case were complications or recurrence of the deformity noted. Pain could be reduced in all patients except one. The radiologic joint situation was Larsen stage 2.2 preoperatively and 2.3 postoperatively.

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INTRODUCTION: Injuries of the sternoclavicular joint are rare. Probably these injuries are frequently missed. Distorsion type lesions mostly heal uneventfully. Their diagnosis and treatment may be demanding. Untreated, a dislocation of the sternoclavicular joint and dislocation fractures may lead to considerable discomfort or even a risk for neurovascular damage. This work focuses on the anatomy and lesions of the sternoclavicular joint, the pathomechanism of the injury and the treatment options according to our acute trauma-patient collective. METHOD: Five patients with sternoclavicular impairment have been assessed. Radiological evaluation consisted in standard chest X-rays. In the situation of a fracture and/or complete luxation, CT scans of the sternoclavicular joints were additionally performed. Two of our patients underwent surgery (one osteosynthesis with a plate and one reduction and ligament reconstruction were performed), in one case dislocation was reduced in a closed way in a short-lasting general anaesthesia and in two cases conservative treatment was performed. RESULTS: In all cases the chosen treatment protocol led to symmetrical arm function and all patients were pain-free 2 to 6 months after the injury. In one patient the plate was removed 4 months after osteosynthesis. CONCLUSION: Distorsions of the sternoclavicular joints are probably underdiagnosed and often mildly symptomatic. Conservative treatment usually leads to satisfying functional results with significant pain reduction. Non-reducible dislocations and dislocation fractures have to be treated operatively. Many different open procedures have been described, such as ligament reconstructions and osteosynthesis. The postoperative results are generally good, but operative treatment may be difficult and at risk for complications. Indications for operative treatment of joint subluxation should be strictly limited because of the high risk of accompanying neurovascular impairment during manipulation and fixation.

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PURPOSE: The aim of this study was to assess the results of operative treatment for rheumatoid swan neck deformity using Littler's technique consisting in the reconstruction of the oblique retinacular ligament. PATIENTS AND METHOD: From 2004 to 2007 twenty rheumatoid patients with 30 PIP-joints affected by swan neck deformity underwent surgical correction. In all cases the tenodesis described by Littler was used. Modification of the operative procedure because of insufficiency of the Cleland ligament or the A2-pulley was in no case necessary. Twenty six PIP-joints in 17 patients could be examined after an average follow-up of 22 months. In two PIP-joints the deformity was contract and in 12 PIP-joints partially contract. In 10 joints a dorsal arthrolysis had to be performed and in one a lengthening of the central slip. All PIP-joints were transfixed in 30 degrees flexion. After 6 weeks the transfixing wire was removed and active PIP- joint mobilisation was allowed. Active extension was limited to 20 degrees of flexion until the end of the 12 (th) postoperative week. During this time an extension blocking splint was used. After the 12 (th) week free active and passive mobilisation of the PIP-joint was allowed. In a retrospective study pre- and postoperative range of motion, X-ray findings, pain and patient's content were examined. RESULTS: Swan neck deformity was corrected in all cases. Preoperative hyperextension of 21 degrees on average was corrected to 24 degrees of flexion. Thereby the ROM of 48 degrees was shifted from the extension sector to a ROM of 51 degrees towards the flexion sector. Recurrence of the deformity or complications were not noted. Pain could be reduced except in one patient. Radiologic changes were classified Larsen grade 2.2 before and 2.3 after operation. CONCLUSION: With the oblique retinacular ligament repair described by Littler reliable results can be achieved in rheumatoid swan neck deformity. It is indicated in contract and non-contract rheumatoid swan neck deformity when th PIP-joints are radiologically in a stage of less than Larsen grade 3. It corrects the deformity at the level of the PIP-joint as well as the DIP-joint.

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AIM: Successful four-corner fusion after scaphoid excision provides pain relief und preserves an acceptable movability of the wrist. However, this treatment option for advanced carpal collapse is not without complications, such as malunion, hardware impingement or incomplete correction of lunate extension. K-wires, staples, Herbert screws or, recently, locking plates are all possible fixation techniques after scaphoid excision. Only a few studies including mid-term results using K-wires are available. The aim of our study was to evaluate clinical and radiological mid-term results after scaphoid excision and four-corner arthrodesis using K-wires for stage II and III scapholunate and scaphoid non-union advanced collapse. METHOD: Twelve wrists of 11 patients (4/SNAC II degrees, 3/SNAC III degrees, 0/SLAC II degrees, 5/SLAC III degrees) were treated operatively by scaphoid excision and four-corner arthrodesis. Four K-wires were used for osteosynthesis. After an average follow-up of 60.25 months, reexamination included subjective, objective and radiological values. Clinical examinations covered wrist motion, grip strength and pinch strength. These parameters were compared with preoperatively collected data and values of the unaffected side. The DASH score (disabilities of the arm, shoulder and hand), Cooney score and the visual analogue scale (VAS 0-10) were analysed. Radiographic assessment of consolidation was verified by conventional X-rays. The carpal height was compared to the preoperative value by assessing the Youm index. RESULTS: All patients were satisfied, pain relief was reported and displayed on VAS from 7.4 (5-10) to 1.4 (0-5). The mean flexion-extension arc of 76.3 +/- 28.8 degrees (59.7% of the opposite wrist), preoperatively 75 +/- 17.3 degrees, was documented. The average total arc of ulnar and radial deviation was 37.5 +/- 9.2 degrees (51% of the opposite wrist). The preoperative value was 33.5 +/- 9.8 degrees. Further clinical evaluation yielded a mean grip strength of 39.3 kp (89.5% of the anaffected side) and pinch strength of 7.6 kp (81.7%). Total DASH score and Cooney score averaged 15 and 74.17 points, respectively. Osseus consolidation was observed radiologically in all patients already after 6 weeks. The Youm index decreased from 0.55 +/- 0.054 to 0.51 +/- 0.057. The radiolunate joint space remained unaltered in height. There were no infections. Except for wire removal, no additional surgery was necessary. CONCLUSION: Scaphoid excision and four-corner arthrodesis for advanced collapse of the wrist enjoy great satisfaction by the patients, with a high degree of pain reduction. This method shows persistent strength and movability in mid-term-results. Compared to alternative fixation techniques, the use of K-wires is a low-risk and low-cost treatment option, although removal of the K-wires is commonly necessary.

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Malunions are fractured bones that have healed in pathological positions. This leads to nonphysiological load transfer. Clinical symptoms at the ankle may include swelling, pain and impaired function. Lateral, posterolateral or posteromedial subluxation of the talus will be visible on the radiographs. Surgical correction may be indicated if the malunion is symptomatic. Different osteotomies have been described, but the goal of surgery will always be the reduction and retention of the subluxed talus in an effort to recreate stable conditions. Eighty percent of patients show good results with significant pain reduction in mid-term follow-up studies. Ankle arthrodesis after corrective osteotomy is rarely necessary.

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INTRODUCTION: Open reduction and internal fixation of multifragmentary intra-articular fractures of the distal humerus often do not provide satisfactory results in elderly patients with osteoporosis. METHOD: From December 2001 to January 2008 a total elbow arthroplasty (Coonrad-Morrey, Zimmer, USA) was performed on 12 patients (average age 81+/-9 ears) who presented with a type C distal humeral fracture. The mean time of follow-up with clinical and radiological assessment was 28+/-17 months. RESULTS: The Mayo score showed a good functional result with an average of 81+/-9 out of 100. DASH and SECEC scores showed a fair result with respect to elbow function (43+/-8 and 68+/-7 points, respectively). The average range of motion of all patients was 120-33-0 degrees. Heterotopic ossifications were found by X-ray examination in 4 cases and asymptomatic radiolucent lines in 4 cases. CONCLUSION: Primary total elbow arthroplasty for complex intra-articular distal humerus fractures in elderly patients has good functional results and is an alternative to osteosynthesis.

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AIM: Evaluation of an unconstrained pyrocarbon prosthesis (Ascension) in the treatment of idiopathic degenerative arthritis of the proximal interphalangeal joint of the hand. METHODS: In this study 10 patients (13 implants), that were treated with this type of prosthesis between February 2002 and January 2005 were clinically and radiologically studied. RESULTS: All but one patient were satisfied with the postoperative situation and would agree to another operation. A significant pain reduction was observed. The average ROM was 58 degrees. Five patients demonstrated a free extension, two patients had a swan neck deformity, which could be actively compensated for, and the remaining six patients had an extension deficit of 30-45 degrees. The average flexion was 76 degrees (+/-12 degrees). X-ray examination was unremarkable in eight patients with a regular position of the endoprosthesis. However, in five patients significant radiolucent lines (>or=1 mm) were observed. So far, a luxation of the prosthesis has not occurred and all implants are still in-situ. However, a dorsal tenoarthrolysis had to be performed in 3 patients. CONCLUSION: The results of this study show a high rate of patient satisfaction with a significant pain reduction. A missing osteointegration may be an explanation for the radiological results. The prosthesis has to be closely monitored in the future. Long-term results with a higher number of patients are necessary. A central registry for finger implants is recommended.

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The complex regional pain syndrome type I (CRPS I)-formerly named Sudeck's atrophy or reflex sympathetic dystrophy (RSD)-describes a complex of symptoms with chronic, poorly controllable pain, autonomic, sensomotor and trophic alterations. It is mainly caused by trauma or surgery. We describe the rare case of a spontaneous manifestation of a CRPS I in an adolescent patient with typical clinical and radiological findings and the recurrence of symptoms after a one-year symptom-free interval. Symptoms were resolved by an intense multimodal therapy concept. The likely psychosocial origin in this case is discussed. Clinical appearance, diagnostic means and therapy of the CRPS are described.

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We report the results of a new bone-tendon ligamentoplasty for the reconstruction of chronic injuries of the ulnar collateral ligament at the metacarpophalangeal joint of the thumb. The mean follow-up period was 36 months. Using the Glickel grading system, seven patients had excellent results and one patient had good results. The mean loss of pinch strength was 10% compared with the contralateral thumb. The mean loss of motion at the MP joint was 8%. This technique successfully restores the desired long lasting stability while maintaining mobility of the thumb's metacarpophalangeal joint.

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Preiser's disease--first described by Preiser in 1910--presents the rare avascular necrosis of the carpal scaphoid. There is no consensus with regard to cause and therapeutic procedure to this day. The initially postulated idiopathic origin of the disease is controversial and rare. It is mainly caused by trauma or repetitive microtrauma, but can also occur as a complication of drug therapy. The rare occurrence of necrosis of the carpal scaphoid following chemotherapy is presented. The treatment was resection of the scaphoid and mediocarpal arthrodesis. Clinical appearance, diagnostic work-up, and therapy of the disease are discussed.

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AIM: The benefits of maintaining the pulley function of the flexor retinaculum in carpal tunnel release by lengthening or reconstructing it have been described. Quantitative MR imaging was used to investigate the morphological changes after open carpal tunnel release by such a retinaculum lengthening technique. METHOD: Ten patients had bilateral carpal tunnel MRI pre- and postoperatively. The MRI examinations were performed with a 1.5 Tesla imaging system and wrist coils. Carpal tunnel volume, carpal arch width, median nerve position and flexor tendon position in relation to the hamate-trapezial axis were recorded . RESULTS: Like other methods of carpal tunnel release with complete division of the flexor retinaculum, the retinaculum lengthening technique showed a significant postoperative increase of carpal tunnel volume. Carpal arch width increased only slightly. There was a significant palmar displacement of the median nerve but not of the flexor tendons. CONCLUSION: The findings support the hypothesis that maintenance of the pulley function of the retinaculum may lead to an early postoperative recovery of grip strength. In spite of some difficulties in application quantitative MR imaging may be a useful tool in evaluating the carpal tunnel morphology.

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OBJECTIVE: The aim of this study was the analysis of long-term carpal changes after radiolunate arthrodesis. METHODS: Pre- and postoperative X-rays of 91 wrists in 78 patients with rheumatoid arthritis, who were treated for carpal instability with a radiolunate arthrodesis, were examined concerning the midcarpal joint and the Larsen grade. The mean follow-up was 60 months. RESULTS: After radiolunate arthrodesis the midcarpal joint space remained unchanged in 28%. In 35% secondary arthritis and in 37% further arthritic destruction occurred. The mean Larsen grade increased from 3.2 to 3.8. Six wrists needed complete arthrodesis 25 to 87 months after the primary procedure and one was treated by total wrist replacement. Adaptive changes of the carpus during progressive disease and in secondary arthritis were recognized. Three types of joint lines could be identified: in 35% of the wrists a "perilunar", in 22% a "radio-midcarpal" and in 3% a purely "midcarpal" joint line. In 40% no specific joint line could be identified. CONCLUSION: After radiolunate arthrodesis the carpus remains unchanged in the long run in nearly a third of cases. But even if secondary arthritis or further arthritic destruction occurs as in the remaining cases, the carpus shows an amazing capacity for adaptation. A new intracarpal joint line may develop or the midcarpal joint re-establishes itself.

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