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Abstract
The Sauvé–Kapandji procedure is an established treatment option for distal radioulnar joint dysfunction. We retrospectively analysed 36 patients following Sauvé–Kapandji procedure between 1997 and 2013. Fifteen patients were available for a follow-up after a mean of 13 years (range 6 to 23). Six patients needed revision surgery because of ulnar stump instability. Radiographs and sonography were performed to quantify the instability of the proximal ulnar stump. These showed a radioulnar convergence of 8 mm without weight and 2 mm while lifting 1 kg. Sonographically, the proximal ulnar stump dislocated by 8 mm to the volar side while applying pressure to the palm, compared with 4 mm on the contralateral side. Sonographically measured ulnar stump instability showed a positive strong correlation with the Disabilities of the Arm, Shoulder and Hand questionnaire and Patient-Reported Wrist Evaluations and a negative strong correlation with grip strength and supination torque. Because of the high incidence of revision surgery due to instability of the proximal ulnar stump, we restrict the use of the Sauvé–Kapandji procedure only to very selected cases.Level of evidence: IV
Highlights
Several surgical procedures have been proposed for the management of distal radioulnar joint (DRUJ) osteoarthritis, such as the Darrach procedure (Darrach, 1913), the Sauve-Kapandji (SK) procedure (Sauveand Kapandji, 1936), hemiresection interposition arthroplasty (Bowers, 1985), matched distal ulna resection (Watson et al, 1986) and implant arthroplasty (Herbert and van Schoonhoven, 2007; Masaoka et al, 2002; Reissner et al, 2016; Scheker et al, 2001)
Six patients underwent revision surgery for a painful, unstable ulnar stump; one patient received an ulnar head prosthesis, one a Scheker prosthesis and another four a procedure described by Fernandez
He described a method to stabilize the unstable proximal ulnar stump and proposed the use of an ulnar head prosthesis with its spherical head plunged into a cavity burred into the ulna with the fusion mass intact (Fernandez et al, 2006)
Summary
The SK procedure combines a DRUJ arthrodesis with the creation of a distal ulnar pseudarthrosis for the salvage of DRUJ dysfunction (Sauveand Kapandji, 1936). Numerous soft tissue techniques, including the use of the flexor carpi ulnaris (FCU) (del Pino and Fernandez, 1998; Lamey and Fernandez, 1998), extensor carpi ulnaris (ECU) (Chu et al, 2008; Minami et al, 2000, 2006), a combination of both (Breen and Jupiter, 1989) or allograft (Sotereanos et al, 2014) have been described to stabilize the unstable proximal ulnar stump. We report our results after a mean 13-year (range 6 to 23) follow-up of patients who underwent the SK procedure with specific focus on the instability of the ulnar stump
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