Case Overview: This video describes the management of rheumatoid arthritis affecting the radiocarpal and distal radioulnar joints via radioscapholunate arthrodesis and distal radioulnar joint arthroplasty with the use of a Scheker endoprosthesis in two patients (one patient underwent bilateral procedures). Indications, contraindications, relevant anatomy, technical pearls, potential pitfalls, and long-term outcomes are discussed. Preoperative and postoperative imaging studies are included to highlight technical aspects of the procedure and outcomes.

Method/Technique: A curvilinear incision is made over the dorsoulnar distal forearm in line with the distal radioulnar joint and curving toward the radioscaphoid joint. The fourth extensor compartment tendons are retracted, after which a posterior interosseous neurectomy, a radial styloidectomy, and a distal scaphoid pole excision are performed. Radioscapholunate arthrodesis is completed with the use of two Nitinol staples and autograft. An interval between the fifth and sixth dorsal compartments is used for ulnar head resection, after which a Scheker endoprosthesis is implanted for distal radioulnar joint arthroplasty. Final implant positioning is confirmed via fluoroscopy.

Results: This video discusses the postoperative clinical and radiographic outcomes of two patients and compares those outcomes to published results reported in the literature.

Summary: This video demonstrates radioscapholunate arthrodesis and distal radioulnar joint arthroplasty with the use of a Scheker endoprosthesis to manage pain from rheumatoid arthritis of the wrist and permit functional wrist motion. Indications, contraindications, technical considerations, and outcomes are presented.