Treatment of rheumatoid arthritis of wrist using Ilizarov wrist joint distraction technique: a case report_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 WANG Bin ¹ , GAO Guizu ² , HUO Yongxin ¹ , YANG Huanyou ¹ , JIANG Jiale ²

1. Department of Orthopedics, the Second Hospital of Tangshan, Tangshan Hebei, 063000, P. R. China;
2. Department of Orthopedics, North China University of Science and Technology Affiliated Hospital, Tangshan Hebei, 063000, P. R. China;

Corresponding author：

WANG Bin, Email: wbladyp3@163.com

Keywords：

Ilizarov technique; wrist joint distraction; rheumatoid arthritis

DOI：

10.7507/1002-1892.202501048

Video：

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Objective To report the clinical experience of using Ilizarov wrist joint distraction technique in the treatment of a case of rheumatoid arthritis of the wrist. Methods In January 2019, a 43-year-old female patient with rheumatoid arthritis of the left wrist, complicated by ulnar impaction syndrome, was admitted for treatment. Preoperatively, the active range of motion of the left wrist was as follows: extension 0°-flexion 0°, pronation 65°-supination 35°, and grip strength of 4.0 kg. The visual analogue scale (VAS) score was 9, and the Cooney wrist function score was 15, indicating poor function. As conservative treatment failed to achieve symptom relief, Ilizarov wrist joint distraction surgery was performed. Postoperatively, joint distraction was applied at 2.0 mm increments on postoperative days 2 and 7, in 4 separate sessions. Results Postoperative X-ray film examination at 7 days revealed a distraction of 3.6 mm in the affected wrist joint compared to the contralateral side. The external fixator was removed 2.5 months postoperatively. At 22 months postoperatively, X-ray film and MRI examinations revealed that the joint space of the left wrist had returned to near-normal, with significant reduction in joint effusion and synovial proliferation. The active range of motion of the left wrist improved to extension 15°- flexion 30°, pronation 90°-supination 90°, with a grip strength of 18.0 kg. The wrist pain VAS score decreased to 0, and the Cooney wrist function score improved to 90, indicating excellent function. At 50 months postoperatively, follow-up X-ray film, MRI, and functional assessments showed the results similar to those at 22 months. Conclusion Ilizarov wrist joint distraction may be a viable treatment option for rheumatoid arthritis of the wrist.

1.	Diaz-Gonzalez F, Hernandez-Hernandez MV. Rheumatoid arthritis. Med Clin (Barc), 2023, 161(12): 533-542.
2.	Di Matteo A, Bathon JM, Emery P. Rheumatoid arthritis. Lancet, 2023, 402(10416): 2019-2033.
3.	Sharif K, Sharif A, Jumah F, et al. Rheumatoid arthritis in review: Clinical, anatomical, cellular and molecular points of view. Clin Anat, 2018, 31(2): 216-223.
4.	Conigliaro P, Triggianese P, De Martino E, et al. Challenges in the treatment of rheumatoid arthritis. Autoimmun Rev, 2019, 18(7): 706-713.
5.	Yi J, Liu Y, Xie H, et al. Hydrogels for the treatment of rheumatoid arthritis. Front Bioeng Biotechnol, 2022, 10: 1014543. doi: 10.1016/j.ajps.2024.100887.
6.	Aldegheri R, Trivella G, Saleh M. Articulated distraction of the hip. Conservative surgery for arthritis in young patients. Clin Orthop Relat Res, 1994(301): 94-101.
7.	van Roermund PM, Marijnissen AC, Lafeber FP. Joint distraction as an alternative for the treatment of osteoarthritis. Foot Ankle Clin, 2002, 7(3): 515-527.
8.	Rodriguez-Merchan EC. Joint distraction in advanced osteoarthritis of the ankle. Arch Bone Jt Surg, 2017, 5(4): 208-212.
9.	Khademi-Kalantari K, Mahmoodi Aghdam S, Akbarzadeh Baghban A, et al. Effects of non-surgical joint distraction in the treatment of severe knee osteoarthritis. J Bodyw Mov Ther, 2014, 18(4): 533-539.
10.	Goh EL, Lou WCN, Chidambaram S, et al. The role of joint distraction in the treatment of knee osteoarthritis: a systematic review and quantitative analysis. Orthop Res Rev, 2019, 11: 79-92.
11.	Wang B, Zhang X, Huo Y, et al. Calcaneal lengthening for partial traumatic loss of the calcaneus. Injury, 2019, 50(3): 796-803.
12.	Thaller PH, Fürmetz J, Böcker W, et al. Transverse distraction osteogenesis: New chances for limb salvage? Unfallchirurg, 2022, 125(4): 282-287.
13.	van Valburg AA, van Roermund PM, Lammens J, et al. Can Ilizarov joint distraction delay the need for an arthrodesis of the ankle? A preliminary report. J Bone Joint Surg (Br), 1995, 77(5): 720-725.
14.	Lafeber F, Veldhuijzen JP, Vanroy JL, et al. Intermittent hydrostatic compressive force stimulates exclusively the proteoglycan synthesis of osteoarthritic human cartilage. Br J Rheumatol, 1992, 31(7): 437-442.
15.	van Valburg AA, van Roermund PM, Marijnissen AC, et al. Joint distraction in treatment of osteoarthritis (Ⅱ): effects on cartilage in a canine model. Osteoarthritis Cartilage, 2000, 8(1): 1-8.
16.	Jansen MP, Mastbergen SC, van Heerwaarden RJ, et al. Knee joint distraction in regular care for treatment of knee osteoarthritis: A comparison with clinical trial data. PLoS One, 2020, 15(1): e0227975. doi: 10.1371/journal.pone.0227975.
17.	Chen Y, Sun Y, Pan X, et al. Joint distraction attenuates osteoarthritis by reducing secondary inflammation, cartilage degeneration and subchondral bone aberrant change. Osteoarthritis Cartilage, 2015, 23(10): 1728-1735.

1. Diaz-Gonzalez F, Hernandez-Hernandez MV. Rheumatoid arthritis. Med Clin (Barc), 2023, 161(12): 533-542.
2. Di Matteo A, Bathon JM, Emery P. Rheumatoid arthritis. Lancet, 2023, 402(10416): 2019-2033.
3. Sharif K, Sharif A, Jumah F, et al. Rheumatoid arthritis in review: Clinical, anatomical, cellular and molecular points of view. Clin Anat, 2018, 31(2): 216-223.
4. Conigliaro P, Triggianese P, De Martino E, et al. Challenges in the treatment of rheumatoid arthritis. Autoimmun Rev, 2019, 18(7): 706-713.
5. Yi J, Liu Y, Xie H, et al. Hydrogels for the treatment of rheumatoid arthritis. Front Bioeng Biotechnol, 2022, 10: 1014543. doi: 10.1016/j.ajps.2024.100887.
6. Aldegheri R, Trivella G, Saleh M. Articulated distraction of the hip. Conservative surgery for arthritis in young patients. Clin Orthop Relat Res, 1994(301): 94-101.
7. van Roermund PM, Marijnissen AC, Lafeber FP. Joint distraction as an alternative for the treatment of osteoarthritis. Foot Ankle Clin, 2002, 7(3): 515-527.
8. Rodriguez-Merchan EC. Joint distraction in advanced osteoarthritis of the ankle. Arch Bone Jt Surg, 2017, 5(4): 208-212.
9. Khademi-Kalantari K, Mahmoodi Aghdam S, Akbarzadeh Baghban A, et al. Effects of non-surgical joint distraction in the treatment of severe knee osteoarthritis. J Bodyw Mov Ther, 2014, 18(4): 533-539.
10. Goh EL, Lou WCN, Chidambaram S, et al. The role of joint distraction in the treatment of knee osteoarthritis: a systematic review and quantitative analysis. Orthop Res Rev, 2019, 11: 79-92.
11. Wang B, Zhang X, Huo Y, et al. Calcaneal lengthening for partial traumatic loss of the calcaneus. Injury, 2019, 50(3): 796-803.
12. Thaller PH, Fürmetz J, Böcker W, et al. Transverse distraction osteogenesis: New chances for limb salvage? Unfallchirurg, 2022, 125(4): 282-287.
13. van Valburg AA, van Roermund PM, Lammens J, et al. Can Ilizarov joint distraction delay the need for an arthrodesis of the ankle? A preliminary report. J Bone Joint Surg (Br), 1995, 77(5): 720-725.
14. Lafeber F, Veldhuijzen JP, Vanroy JL, et al. Intermittent hydrostatic compressive force stimulates exclusively the proteoglycan synthesis of osteoarthritic human cartilage. Br J Rheumatol, 1992, 31(7): 437-442.
15. van Valburg AA, van Roermund PM, Marijnissen AC, et al. Joint distraction in treatment of osteoarthritis (Ⅱ): effects on cartilage in a canine model. Osteoarthritis Cartilage, 2000, 8(1): 1-8.
16. Jansen MP, Mastbergen SC, van Heerwaarden RJ, et al. Knee joint distraction in regular care for treatment of knee osteoarthritis: A comparison with clinical trial data. PLoS One, 2020, 15(1): e0227975. doi: 10.1371/journal.pone.0227975.
17. Chen Y, Sun Y, Pan X, et al. Joint distraction attenuates osteoarthritis by reducing secondary inflammation, cartilage degeneration and subchondral bone aberrant change. Osteoarthritis Cartilage, 2015, 23(10): 1728-1735.

Chinese Journal of Reparative and Reconstructive Surgery

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