Trieb's 2008 review covers the full spectrum of surgical management for rheumatoid wrist disease — from early synovectomy and partial arthrodesis to total wrist fusion and arthroplasty — using three named classification systems to match intervention to disease stage and natural-course type.
When staging a rheumatoid wrist, apply the Wrightington and Simmen-Huber classifications together: a Type 3 disintegrative wrist needs early surgical stabilization regardless of pain level, while Wrightington Grade 1–2 disease is still amenable to synovectomy or partial arthrodesis.
For bilateral disease requiring motion preservation, total wrist arthroplasty on the non-dominant side paired with arthrodesis on the dominant side is the author's preferred strategy.
Trieb's 2008 review covers the full spectrum of surgical management for rheumatoid wrist disease — from early synovectomy and partial arthrodesis to total wrist fusion and arthroplasty — using three named classification systems to match intervention to disease stage and natural-course type.
When staging a rheumatoid wrist, apply the Wrightington and Simmen-Huber classifications together: a Type 3 disintegrative wrist needs early surgical stabilization regardless of pain level, while Wrightington Grade 1–2 disease is still amenable to synovectomy or partial arthrodesis.
For bilateral disease requiring motion preservation, total wrist arthroplasty on the non-dominant side paired with arthrodesis on the dominant side is the author's preferred strategy.