B Krieg1, Z Mascharka2, G Maderbacher3, C Baier3, J Grifka3, F Greimel3. 1. Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland. be.krieg@asklepios.com. 2. Klinikum Fulda, Pacelliallee 4, Fulda, 36043, Deutschland. 3. Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland.
Abstract
BACKGROUND: Hand surgery of the rheumatoid hand has undergone significant changes mostly as a result of biologicals and biosimilars. OBJECTIVE: The significance of established and innovative operative procedures in the modern treatment of the rheumatoid hand is elaborated and a subsumption of local interventional options in this context is carried out. METHODS: The analysis, evaluation and discussion of the literature and expert recommendations are presented. RESULTS: With the consistent use of modern antirheumatic drugs the destruction and deformation of the wrist and hand occur more slowly and less severely. The hand surgeon can therefore operate more selectively and focus on less pathologies at the same time. Up to the present many of the operative techniques described by the pioneers of modern hand surgery are still powerful tools. Most of the considerations about the correction of the disturbed biomechanics and about the reconstitution of stability and the range of motion are still valid. The combination of arthroscopic synovectomy and radiosynoviorthesis of the wrist seems to show promising results. CONCLUSION: Modern treatment of the rheumatoid hand is a multidisciplinary challenge. Rheumatologists, nuclear medicine physicians and hand surgeons together can achieve excellent results. A consistent medication, an early operative intervention if necessary and systematic integration of nuclear medicine physicians into the therapeutic process enable preservation of the long-term function of the hand as the main tool in daily life.
BACKGROUND: Hand surgery of the rheumatoid hand has undergone significant changes mostly as a result of biologicals and biosimilars. OBJECTIVE: The significance of established and innovative operative procedures in the modern treatment of the rheumatoid hand is elaborated and a subsumption of local interventional options in this context is carried out. METHODS: The analysis, evaluation and discussion of the literature and expert recommendations are presented. RESULTS: With the consistent use of modern antirheumatic drugs the destruction and deformation of the wrist and hand occur more slowly and less severely. The hand surgeon can therefore operate more selectively and focus on less pathologies at the same time. Up to the present many of the operative techniques described by the pioneers of modern hand surgery are still powerful tools. Most of the considerations about the correction of the disturbed biomechanics and about the reconstitution of stability and the range of motion are still valid. The combination of arthroscopic synovectomy and radiosynoviorthesis of the wrist seems to show promising results. CONCLUSION: Modern treatment of the rheumatoid hand is a multidisciplinary challenge. Rheumatologists, nuclear medicine physicians and hand surgeons together can achieve excellent results. A consistent medication, an early operative intervention if necessary and systematic integration of nuclear medicine physicians into the therapeutic process enable preservation of the long-term function of the hand as the main tool in daily life.