A Comparative Study Between Darrach and Sauvé-Kapandji Procedures for Post-Traumatic Distal Radioulnar Joint Dysfunction

Abstract

Background: There are various treatments for post-traumatic distal radioulnar joint (DRUJ) dysfunction. The present study aimed to assess differences in long-term patient-reported outcomes on physical function, pain, and satisfaction between the Darrach and Sauvé-Kapandji procedures. Secondary aims were to describe the radiographic outcomes and to assess the difference in rate and type of complications and reoperations between these 2 procedures. Methods: We retrospectively analyzed 85 patients who had a post-traumatic DRUJ derangement and had been treated by either a Darrach (n = 57) or Sauvé-Kapandji procedure (n = 28). Fifty-two patients (61%) completed patient-rated outcomes surveys at a median of 8.4 years after their procedure. Radiographic measurements consisted of ulnar distance, radioulnar distance, and ulnar gap (only in Sauvé-Kapandji group). Results: There were no significant differences in Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (UE) Function score, pain score, satisfaction score, complications, and reoperations between patients who had a Darrach procedure or a Sauvé-Kapandji procedure. Seventeen patients (30%) in the Darrach group experienced a complication, and 14 patients (50%) in the Sauvé-Kapandji group experienced a complication ( P = .09). The most common complication was instability of the ulnar stump (n = 10), followed by symptoms of the dorsal sensory branch of the ulnar nerve (n = 8). Patients who underwent a Sauvé-Kapandji procedure had more reoperations for excision of heterotopic ossification. Conclusions: Darrach and Sauvé-Kapandji procedures show comparable long-term patient-reported outcomes in treatment of post-traumatic DRUJ dysfunction. Complication and reoperation rate are relatively high, with non-significant differences between the 2 procedures.

Reconstruction of the distal radioulnar joint with rib perichondrium – midterm follow-up

“…The complication rate was reported to be 30% and 50% respectively, while the reoperation rate was 18% and 36% respectively. Overall, 52 patients (61%) in this study completed a PROS, and the authors did not find any significant difference in pain and satisfaction rate in between the two groups [ 2 ]. In a recent long-term follow-up study of the Sauve-Kapandji procedure, Nagy et al found a high incidence of revision surgery due to instability to the proximal ulnar stump and recommended a restriction of this method to only very selected cases [ 5 ].…”

“…total (Darrach) or partial (Bowers) resection of the ulnar head, and the Sauve-Kapandji procedure [ 1 ]. The resulting condition after these traditional procedures may cause painful impingement between the distal ulnar stump and the radius during manual load [ 2 ] and are commonly used in older individuals with rheumatoid changes [ 3 ]. In the Bowers procedure, sufficient soft tissue surrounding the joint is mandatory in order to avoid stylocarpal impingement, which is a potential complication [ 3 ].…”

“…In the literature the complication rate has been reported to vary considerably, between 14–44% [ 3 , 4 ]. High complication rates have been described for both the Darrach (30%) and the Sauve-Kapandji (50%) procedure [ 2 , 5 ]. The results after implant arthroplasty have improved but there are still problems with restricted range-of-motion, persistent pain, implant loosening and instability.…”

Ossification of the pseudarthrosis following the Sauvé-Kapandji procedure: a case report and review of the literature

“…Verhiel et al. [ 15 ] comment that prior trauma and preparation of the DRUJ for fusion may create a stimulus for heterotopic ossification and that it is more likely to occur with incomplete resection of the ulnar periosteum, while there is also mention of an intraperiosteal resection technique [ 16 ], which leaves periosteal tissue in the pseudarthrosis gap. In our case, an intraperiosteal osteotomy was performed during index surgery, of which the remaining periosteum was utilized as interposition material.…”

“…In our case, radiologic evidence of ossification was noted 17 months after surgery and progressed precipitously to near complete synostosis within 18 months postoperatively with concomitant loss of pronation and supination. With the distal radioulnar arthrodesis-hardware out of reach of the proximal ulnar stump, the remaining potentially stimulating and modifiable factors at the osteotomy site is limited to soft tissue interposition-, stabilization, or suspension methods previously described by several authors ( Table 1 ) [ 5 , 9 , 10 , 15 , 17 ]. However, according to this literature review, no significant pattern can be elucidated when evaluating for a trend of ossification towards one specific procedure modification.…”