Radiocarpal Fusion

Radioscapholunate (RSL) fusion for post-traumatic radiocarpal arthritis
Radiolunate (RL) fusion to prevent ulnocarpal subluxation in rheumatoid arthritis (RA).

Remove articular cartilage and subchondral plate down to bleeding cancellous bone from reciprocal surfaces of scaphoid (S), lunate (L), and radius (Fig. 52-1).
Retrograde 0.062 in. pins through scaphoid and lunate.

Figure 52-1

Pins in lunate pass through triquetrum without fusing lunotriquetral joint.

Reduce lunate and scaphoid so that the radiolunate
Radiolunate (RL) angle is 0 degrees on a lateral radiograph.
Advance pins. Check reduction with intraoperative imaging (Fig. 52-2).
For RL fusion, remove articular cartilage and subchondral bone from reciprocal surfaces of lunate and radius.
Retrograde two 0.062 in. pins into lunate (Fig. 52-3).
Reduce lunate on radius.
Advance pins across RL joint (Fig. 52-4).
Check image.
Assess distal radioulnar joint (DRUJ). Decide if hemior complete resection of distal ulna is necessary.
For both fusions cut pins beneath skin.