Current recommendations for surgery of the rheumatoid hand and wrist.

Treatment of the hand with rheumatoid arthritis has not changed significantly over the past year. Two studies indicated that methotrexate administration need not be discontinued prior to surgery. Electron microscopy has shown that rheumatoid tendons are morphologically different from normal tendons. Early synovectomy has been reintroduced as a valuable technique, and the need for a team approach in disease management has been emphasized. Several authors emphasized rigid surgical fixation to improve digital and wrist fusions. Three studies reported good long-term results from metacarpophalangeal joint arthroplasty. Derangements of the distal radioulnar joint can benefit from the Sauve-Kapandji procedure. A newer technique to stabilize the distal ulna following the Darrach procedure was introduced, also, the treatment of swan-neck and boutonniere deformities, the results of which were somewhat disappointing, was reviewed.