[Surgical treatment of the rheumatoid hand]

In rheumatoid arthritis, involvement of the hand is serious, frequent and occurs early. It reaches synovial sheets, articular or tendinous, and causes painful and invalidating deformities. Our experience, based on 537 operations of the hand, indicates that reconstructive surgery can be practised at all levels. For the wrist, inferior radio ulnar arthrodesis strengthens the articulation and eradicates pain when performed in the early stage. Segmentar resection of ulnar diaphysis ensures the conservation of "prono- supination". In the case of destruction or luxation of the wrist, a choice has to be made between prosthesis and arthrodesis. We tend to prefer the latter which confers a strong, painless and definitive articulation. Ulnar deviation of metacarpo-phalangeal articulations of long fingers can be corrected by ligamentar or tendinous plasties. But the results are not always durable and they cannot be used when the articulations are destroyed. In that case prostheses have to be implanted. Swanson's silastic implants enable to straighten the fingers and to suppress pain but ensure a limited mobility. Likewise, interphalangeal deviations generally call for implants or arthrodeses. Trapezo-metacarpal or phalangeo-metacarpal deformities of the thumb are stabilised by arthrodeses, ensuring a strong and painless prehension. In conclusion, reconstructive surgery allows many possibilities but its results are often incomplete. It is therefore advisable to perform synovectomy as early as possible before the occurrence of deformities. Surgical synovectomy competes with isotopic, chemical or corticoid synoviosthesis. But at tendinous level, synovectomy alone should be used, since it gives excellent results. Even though rehabilitation after synovectomies is not always easy, we hope that it will prevent the occurrence of articular or tendinous destruction for many years.