Résumé
The involvement of the wrist and hand in rheumatoid arthritis is frequent, variable in its presentation, heterogeneous from the evolutionary point of view, and closely linked to the functional future of the hand. Surgery obeys certain rules and is only conceived within the framework of a structured medical-surgical collaboration considering the patient as a whole. Surgical indications for the wrist and hand are given in the event of noneffectiveness of medical treatment for chronic pain, persistent joint synovitis, or chronic tenosynovitis likely to create tendon ruptures, but also in the event of painful limitation of supination, deformation likely to create complications, or proven tendon or neurological complications. Surgical management of the rheumatoid wrist and hand aims to ensure correct function without restoring normal anatomy by providing indolence and stability. The achievement of mobility is underpinned by the state of the joint spaces and the bone stock. The determination of the evolutionary profile of the disease at the wrist will be of great help in the surgical decision. The different techniques applied to surgery of the rheumatoid wrist and hand will be discussed, making a distinction between palmar and dorsal wrists on the one hand and digital deformities on the other. Conservative and nonconservative procedures will be described.