Abstract
Our case report focuses on a 64 year old patient with rheumatoid arthritis after implantation of a total wrist replacement. The implant got infected and the infection was confirmed approximately 7 months after implantation.
Cultivation revealed the presence of coagulase negative streptococcus. The patient was initially treated conservatively (antibiotics administered according to microbial sensitivity), followed by revision surgery with continuous closed irrigation-suction system.
However, this did not cure the infection and implant had to be removed 9 month after the primary implantation with application of another continuous closed irrigation-suction system, volar cast immobilization and intravenous antibiotics administration. Wrist fusion was performed after another 8 months as soon as the inflammation markers were normalized, the bone substrate was consolidated and cultivation was repeatedly negative.
We have used our own method using special L-shaped plate designed for wrist arthrodesis, manufactured by the Poldi company. Due to the large bone defect, we had to perform modified Brunelli method of bridging corticospongious graft taken from distal part of the radius.
In our modification we distalised the graft in its bed so that it could reach the dorsal aspect of the carpus. We also had to perform reconstruction of extensor tendon of IV. digit due to spontaneous rupture.
We used end-to-side suture to extensor tendon of III. digit. Wrist was immobilized by volar cast for 4 weeks followed by bracing for another 6 weeks.
Wound was closed per-primam, graft healing was observed by x-ray. Currently the fusion is fully healed in neutral position.
There is no significant impairment to hand grip and supination-pronation movements are free.