A 42-year-old male farmer with rheumatoid arthritis has a single destroyed, painful, unstable right wrist with marked bone loss on radiographs. His left wrist is normal and he performs heavy manual work requiring strength. The most appropriate reconstructive procedure is:

• A Total wrist arthroplasty
• B Total wrist arthrodesis ✓
• C Proximal row carpectomy
• D Silicone scaphoid interposition arthroplasty

Explanation

For a young manual laborer with unilateral rheumatoid wrist destruction who values stability and power grip over mobility, arthrodesis is preferred because it provides a strong, stable, durable, painless wrist, whereas any arthroplasty risks loosening and failure under heavy loads. Total wrist arthroplasty suits older, low-demand patients with bilateral disease who need some motion for activities of daily living. Proximal row carpectomy requires intact lunate fossa and capitate cartilage, unavailable here. Silicone implants are abandoned for load-bearing joints due to particulate synovitis and fracture.

Reference: Campbell's Operative Orthopaedics, 14th ed.

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Written and medically reviewed by the StethoPrep medical team.