Serious Complication of Sauve-Kapandji Procedure for Distal Radioulnar Joint Reconstruction-A Case Report and Literature Reviews

Abstract

Several methods of surgical treatment for distal radioulnar joint (DRUJ) disorders have been proposed. Recently, there has been an interest in the Sauve-Kapandji procedure as a treatment for severe DRUJ disorders. In 1936, Sauve and Kapandji described this procedure that included an arthrodesis of the distal radioulnar joint and a pseuoarthrosis of the ulna, proximal to the fusion. Theoretically, pain is eliminated by the arthrodesis; and pronation and supination are regained by the creation of a pseudoarthrosis. In this article, we present a patient with distal radioulnar joint injury who bad previously received four surgical procedures at other hospitals, including the Sauve-Kapandji procedure. Unfortunately, severe limitation of forearm supination, which was only 10° and grip weakness were noted. Forearm pronation contracture due to interosseous membrane contracture was suspected. Surgical procedures including (1) release of scarred interosseous membrane and pronator quadratus muscle for forearm rotation and (2) extensor carpi ulnaris (ECU) tenodesis for proximal ulnar instability, (3) removal of bone chip at ECU insertion for tendinitis were performed. Postoperative 3 months follow-up revealed that the grip strength increased to 32 kg from 10 kg before surgery and the range of forearm supination regained 50° from 10° before surgery. Although Sauve-Kapaudji procedure is indicated for intractable distal radioulnar joint disorder, good surgical technique, minimal manipulation of soft tissue and postoperative rehabilitation are important to prevent such a serious complication. On the other hand, after release of interosseous membrane contracture, extensor carpi ulnaric tenodesis bad better be used for prevention of proximal ulnar stump instability.