Stabilization of the Proximal Ulnar Stump after the Darrach or Sauvé-Kapandji Procedure by Using the Extensor Carpi Ulnaris Tendon

Abstract

The Darrach and Sauvé-Kapandji procedures are considered to be useful treatment options for distal radioulnar joint disorders. Postoperative instability of the proximal ulnar stump and radioulnar convergence, however, may cause further symptoms. From October 1999 to May 2002, a total of 19 wrists in 15 men and four women, with an average age of 48.3 years, were treated by stabilizing the proximal ulnar stump with a half-slip of the extensor carpi ulnaris tendon using modified Darrach and Sauvé-Kapandji procedures. The average follow-up period was 77 months (range, 62 to 91 months). No patient complained of symptoms due to instability of the proximal ulnar stump. Grip strength improved in all wrists after surgery. Postoperative X-rays, including loading X-rays, showed improved alignment in both coronal and lateral planes. We concluded that stabilization of the proximal ulnar stump with ECU tenodesis is an effective procedure for treating distal radioulnar joint disorder after the Darrach and Sauvé-Kapandji procedures.

Proximal Ulnar Stump Stability After Using the Pronator Quadratus Muscle Transfer Combined With the Suavé-Kapandji Procedure in Rheumatoid Wrist

“…Extended usage of this technique in the Darrach procedure was also reported with comparable results. 14 The pronator quadratus (PQ) muscle used as the proximal ulnar stump stabilizer in the Darrach procedure had been reported by various authors. 10 , 11 Combination of the PQ muscle and the distally based strip of the ECU tendon for salvage of the failed Darrach procedure was also reported.…”

Assessment and Treatment of Extensor Carpi Ulnaris Tendon Pathology

“…A retrospective review of sixteen patients who underwent this modified procedure demonstrated marked alleviation of pain in fifteen of sixteen wrists at a follow-up of thirty-seven-months (range, twentyeight to forty-seven months) 37 . Chu et al performed a Level-III comparative retrospective review of nineteen wrists with stabilization of the ulnar stump following the modified Darrach or Sauvé-Kapandji procedures 40 . Ulnar stability was assessed radiographically by asking the patient to hold a 5-lb (2.2-kg) cylinder with the shoulder abducted and elbow flexed at 90°and the forearm in neutral rotation 40 .…”

“…Chu et al performed a Level-III comparative retrospective review of nineteen wrists with stabilization of the ulnar stump following the modified Darrach or Sauvé-Kapandji procedures 40 . Ulnar stability was assessed radiographically by asking the patient to hold a 5-lb (2.2-kg) cylinder with the shoulder abducted and elbow flexed at 90°and the forearm in neutral rotation 40 . No patients reported pain or symptoms due to stump instability.…”

Resection Interposition Arthroplasty for Failed Distal Ulna Resections

“…Varying degrees of success have been reported, and no technique has demonstrated clinical superiority. [11][12][13][14][15][16][17][18][19][20] Implant replacement of the distal ulna is an effective treatment for the symptomatic patient after Darrach distal ulna resection. Reports by many investigators are encouraging.…”

“…The reported techniques include stabilizing soft tissue procedures, further shortening of the ulna, wide resection of the ulna, lengthening of the ulna, and other more complex procedures. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Several soft tissue procedures using part of the flexor and/ or extensor carpi ulnaris tendons to stabilize the ulnar stump have been described. [11][12][13][14][15][16][17] These procedures are technically demanding, and their results are not reproducible.…”