Radiographic Parameter Analysis on Modified Sauvé-Kapandji Procedure

Abstract

Severe arthritis or derangement of the distal radioulnar joint (DRUJ) leads to instability of the DRUJ, and the subluxation of the ulna causes pain on motion, loss of grip strength, and a restriction of forearm rotation. 1 A variety of surgical procedures have been described to treat these. 2 In 1912, Darrach described a resection of the ulnar head. 3 Although this procedure could successfully restore forearm rotation, serious postoperative complications frequently occurred, such as a further loss of grip strength or pain over the proximal ulnar stump. [4][5][6] As an alternative solution, Sauvé and Kapandji described a distal radioulnar arthrodesis combined with an intentional pseudarthrosis of the distal ulna. 7 Some reports of this technique have shown superior results both clinically and radiographically, [8][9][10][11] and hence the Sauvé-Kapandji (S-K) procedure has almost replaced Darrach's as the most common resection arthroplasty for the treatment of DRUJ dysfunction. The conventional S-K procedure is contraindicated, however, in patients with extremely poor bone quality, which AbstractPurpose The Sauvé-Kapandji (S-K) procedure is now an established treatment option for symptomatic distal radioulnar joint (DRUJ) dysfunction. However, for patients with poor bone quality (frequently as a result of advanced-stage rheumatoid arthritis [RA]), the conventional S-K procedure is difficult to perform without reducing the radioulnar diameter of the wrist, which may result in a loss of grip strength and pain over the proximal ulnar stump. The purpose of this study was to review the radiographic outcomes of patients who underwent a modified S-K procedure that involves rotating the resected ulnar segment 90 degrees and using it to bridge the gap between the sigmoid notch and the ulnar head. Methods The modified S-K procedure was performed in 29 wrists of 23 patients. Twenty-one patients had severe RA, while two had malunited radius fractures. The mean follow-up period was 43 months (range, 23 to 95). The radiographic evaluation included a measurement of the radioulnar width, the pseudarthrosis gap between the proximal and distal ulnar stump, the radioulnar distance, and the ulnar translation of the carpus. Results The radioulnar width of the wrist, pseudarthrosis gap, and radioulnar distance were well maintained throughout the period. A postoperative loss in the radioulnar width of the wrists appeared to correlate with a postoperative additional ulnar translocation of the carpus. Conclusion Narrowing of the radioulnar width of the wrist is a potential cause of progressive ulnar translocation of the carpus. The modified technique for the S-K procedure maintains the distal ulna in the proper position and provides sufficient ulnar support for the carpus. It is a useful reconstruction procedure in patients with severe RA with poor bone quality.

One-Bone Forearm Reconstruction and Distal Radioulnar Joint Fusion for Emergency One-stage Operation in Traumatic Major Bone Defect of Forearm

“…Simple OBF reconstruction can generally cause wrist longitudinal instability, DRUJ instability and chronic pain [10]. Ota et al [21] also consider that the wrist width loss after Sauvé-Kapandji procedure is associated with the aggravated carpal ulnar deviation, therefore, attention should be paid to maintaining the original wrist width to prevent progressive ulnar deviation of the wrist. OBF reconstruction was generally used alone.…”

Modified Sauve-Kapandji procedure for patients with old fractures of the distal radius

“…All patients achieved osseous union, wrist pain resolved or decreased, and means total range of forearm rotation increased by 23°. Ota N et al [ 19 ] concluded modified Sauve-Kapandji procedure was a useful reconstruction procedure in patients with severe RA with poor bone quality. 29 wrists of 23 patients were performed operation that involves rotating the resected ulnar segment 90 degrees and using it to bridge the gap between the sigmoid notch and the ulnar head.…”

“Quadrangular-construct” modification of Sauve-Kapandji procedure

“…Ota et al . 17 in 2013 reported satisfactory results with their own 1 modification of S-K procedure in which resected piece of ulna was used as a graft between ulnar head and ulnar notch of radius. The authors found that radioulnar width of the wrist, pseudarthrosis gap, and radioulnar distance were well maintained throughout the period.…”

“…Although satisfactory results are obtained in most cases, the instability of the proximal ulnar stump in both coronal, as well as sagittal planes remains the major complication causing pain and discomfort while doing daily activities, especially in pronation. 13 14 15 16 17 …”