Figure 11b. (a, b) Anteroposterior (a) and oblique (b) radiographs of the right hand in a patient with rheumatoid arthritis show multiple devices implanted for wrist and first MCP joint fusion: Swanson silicone devices for the MCP joints with circumferential titanium grommets (note abnormal orientation of the distal grommet of the second MCP joint), silicone elastomere capping of the distal ulna (Swanson), fusion of the third through fifth PIP joints with Acutrak screws (Acutrak screw system; Acumed, Hillsboro, Ore), and an additional Kirshner wire through the fourth PIP joint. (c) Anteroposterior radiograph of the same hand after removal of the failed distal grommet from the second MCP joint and the Kirshner wire.