Assessment of Sauvé-Kapandji procedure as a treatment for malunited distal end radius fractures with limited forearm rotation

Abstract

Background The most common cause of residual wrist disability after fracture distal radius involves shorting of the radius and ulnar side of the wrist. The three basic conditions responsible for pain associated with limitation of forearm rotation are incongruency, impaction, and instability of the distal radioulnar joint. Sauve-Kapandji procedure is a simple procedure to restore forearm rotation and to relieve pain. Aim To evaluate the results of Sauve-Kapandji procedure for management of distal radioulnar joint disruption after malunited distal radial fracture with shorting to restore forearm rotation and relieve pain. Patients and methods A total of 15 patients with painful and limited forearm rotation owing to malunited distal end radius fracture were treated with Sauve-Kapandji procedure. There were nine males and six females, with a mean age 45 years, with range from 25 to 70 years. They were followed up for a mean time of 16 months, with range 12–24 months. Results All arthrodesis sites were united at a mean time of 11.2 weeks (range, 8–15 weeks). Preoperative pronation/supination arc was 57.5°, (range, 35–90°), and postoperative arc was 140°, (range, 120–155°) (P˂0.05). Preoperatively, the pain was 6.3 on numeric rating scale for pain (range, 5–8). Postoperatively, the mean score was 2, with range from 1 to 4 (P˂0.05). At 12-month follow-up, grip strength measured 86% of the contralateral side compared with 47.9% preoperatively (P˂0.05). All 15 patients were functional with respect to daily household activities, eleven previously working patients were back to work, and all patients felt that their postoperative status has a significant improvement over their preoperative status. Conclusion Sauve-Kapandji procedure is simple and effective in restoring pronation and supination, diminishing wrist pain, and increasing function in patients with limited painful forearm rotation as a result of malunited distal radius fracture with disruption of inferior radioulnar joint.