An approach to complex rheumatoid hand and wrist problems

Successful surgical reconstruction of the hands in patients with rheumatoid arthritis depends upon knowledge of the pathophysiology of the deformities and available surgical options, the use of appropriate operative and rehabilitative techniques, and, perhaps most importantly, a well-considered strategy for indicating and performing surgical procedures. In the case of complex hand deformities, two general approaches have guided the development of operative strategies. The first and most widely used strategy generally has involved sequential procedures. A less widely used but highly effective strategy uses multiple, concurrent procedures. Although it can be argued that both strategies are comprehensive, they are distinctly different. This article explores and defines the multiple, concurrent operations strategy and presents indications for and examples of its application. In contrast to sequential operations, in comprehensive reconstruction, all operations are done concurrently, providing that specific criteria are satisfied. When appropriately indicated by a hand surgeon experienced in all the technical components, a comprehensive strategy of rheumatoid hand reconstruction using multiple, concurrent operations can be highly effective. The strategy can provide restoration of patients' function and improve the quality of their life without compromising the results of any one component of the operation.