Realignment stabilization synovectomy in the rheumatoid wrist. A study of twenty-five cases

The authors studied a series of 25 rheumatoid wrists, stages II and III according to Steinbrocker or Larsen, treated between 1981 and 1983 by realignment-stabilization synovectomy. The mean follow-up period was 2 1/2 years. The different steps of the operation--articular and tenosynovectomy, tendon transfers associated with dorsal ligamentoplasty--have an additive effect in achieving relief of pain, with preservation of the pre-existing mobility and long-term stability in both the frontal and sagittal planes. In other studies, resection of the ulnar head results in a 40 p. cent increment in instability with notably aggravation of ulnar sliding. Preservation of the distal radioulnar articulation according to Sauve-Kapandji's operation constitutes a new approach to rheumatoid arthritis and, in our opinion, appears to be simple and is very efficient in stabilizing the wrist immediately, thus allowing early rehabilitation of these patients. Long-term stability is affirmed by clinical and roentgenologic follow-up.