According to authors investigating problems with the hand in rheumatoid arthritis (RA), up to 95 % of patients suffer due to wrist involvement after 8–12 years from the onset of the disease. In a high activity and a progressive pattern of RA, wrist damage occurs earlier. The question is what to do when pain and instability are dominant factors and at the same time the x-rays show only a mild or moderate degree of destruction of the joint. Trying to find an alternative procedure to a more radical surgery, in 1995 I started surgical stabilization using a pedicled flap of the joint capsule and the extensor retinaculum.

Material and methods: 44 wrists in 36 patients were treated with this method. The patients were 34 women and 2 men at the ages from 24 to 73 (49 on average). The follow-up was from 2 to 9 years (average > 6). The operation was done through a dorsal approach. After synovectomy of the wrist, the capsular pedicled flap was prepared, in a case of subluxation, the carpal bones were repositioned and two mattress strong stitches were put on through the capsule flap and proximal and distal row of carpal bones. The joint was closed with single stitches. Depending on the pathology, hemi- or total- resection of the ulnar head was combined with the procedure. In some cases, a repair of the ruptured extensor tendons was necessary. Immobilisation in the palmar splint for 6 weeks was recommended, and then a rehabilitation program started.

Results: 25 wrists (63 %) at the latest follow-up were free from pain and stable, 8 (20 %) were stable but mildly and occasionally painful, 4 were moderately painful, and 3 needed arthrodesis because of the marked bone destruction and pain. The power of the combined grip was significantly improved in 31 wrists (77 %); moderate improvement was in 6 cases (15%).

Conclusion: Stabilisation of the painful and unstable wrist with the use of the method described above gives good results and seems to be a valuable procedure even in selected cases qualified as arthrodesis.

Angiogenesis, the growth of new blood vessels from pre-existing vasculature has an obvious and essential role in soft and hard tissue repair. During the wound healing many potential angiogenic factors are released and may be found in circulating blood. The most important are basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF).

Experimental data confirm the important role of VEGF and bFGF in wounds and bone healing. It was proved that heparin and its low-molecular derivatives may interfere with various steps of angiogenesis process. Enoxaparine (En) is frequently used as anticoagulant for prophylaxis of thromboembolic complications. The aim of this study was to evaluate in vivo angiogenic potency and VEGF and bFGF content of sera collected from 7 patients after hip surgery, treated for 14 days with 40 mg of En (Clexane, Aventis) daily. Evaluation of angiogenic activity was performed twice before surgery (before and 1 day after one En dose) and 14 days after surgery. Sera were injected intra-dermally to anaesthetized Bal/c mice and 72 hours later the number of newly-formed blood vessels was counted in dissecting microscope (SIA test). Cytokines concentration was estimated by ELISA. Results: Sera obtained after one En dose presented increase of angiogenic activity (57,3+/− 2,4, n=112, p< 0.01)in comparison to the value before En (44.6 +/− 2.5, n=113 of newly-formed blood vessels. After 14 En doses, further increase was observed (72 +/− 4.9 blood vessels, n= 112).

BFGF levels increased after the first En dose, VEGF concentration was significantly higher after 14 injections as compare to the results obtained before or after one injection of En.

Conclusion: Beneficial effect of 14-days prophylaxis with enoxaparine on healing process might be expected in patients after hip surgery.