Amélioration technique de l'opération Kapandji-Sauvé, dite « Technique III

Abstract

The tendon of the ECU in its sheath is the main element of stability of the ulnar stump. In the original procedure, it was necessary first to cut the ulna for downwards tilting of the ulnar head, so as to open the distal radio-ulnar joint to remove its cartilages. It is better to leave the ulnar head in place, just widening the dorsal aspect of the DRUJ and peel its cartilages. The ulnar head is then fixed with a cancellous screw in its place in the sigmoid notch. Just above this fixation, it is necessary to separate the ECU tendon included in its sheath from the ulnar shaft, only along a limited line 10-15 mm long, where the ulnar resection will be made. The ECU tendon is therefore not disconnected from the ulnar stump, which is better stabilized. In contrast with the original technique the ulnar resection is made in a second stage, with two ents: a distal and transverse ent, above the head fixation, and a proximal and oblique ent, making a tip on the medical side of the ulnar stump. Ulnar resection is consequently minimized by means of this obliquity. It is very important to check that this tip is 5 mm from the ulnar head cut in supination. The first eight cases show better stability of the stump and fast recovery of amplitudes of prono-supination. The patient feels "comfortable" after a period of two to six months. These advantages justify replacement of the previous technique by this procedure.