Proximal Ulnar Stump Research Articles

Ulnar Buttress Arthroplasty without Ulnar Stump Stabilization for Giant Cell Tumor of Distal Ulna.

Purpose Reconstruction and stabilization of ulnar stump after distal ulna tumor resection is still a matter of debate. We present the outcomes of ulnar buttress arthroplasty without stabilization of the ulna stump in giant cell tumor of bone (GCTB) of the distal ulna. Methods Evaluation of functional outcome was performed using Musculoskeletal Tumor Society 93 (MSTS93) score, Modified Mayo Wrist score (MMWS), and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. We also assessed the hand grip strength, range of motion at the wrist, and ulnar carpal translation. Results The study included 8 patients with Campanacci grade 3 GCTB of the distal ulna with a mean follow-up of 35.5 ± 9.1 months. The mean resection length was 7.7 ± 1.3 cm. The mean hand grip strength on the operated side was noted to be 90 ± 0.04% of the contralateral side. Mean MSTS93 score was 27.9 ± 1.25, mean MMWS was 86.9 ± 4.58%, and the mean DASH score was 4.9 ± 1.67, depicting a good to excellent functional outcome with low degree of disability. No radiocarpal instability, ulnar carpal translation, prominence, or instability of the proximal ulnar stump was noted in any patient. Conclusion Reconstruction of the distal radioulnar joint using iliac crest bone graft for ulnar buttress without stabilization of the ulnar stump after resection of the distal ulna is an effective reconstruction option with good functional outcome and preservation of good hand grip strength. Level of Evidence Level IV, Therapeutic study.

The Sauvé-Kapandji procedure for post-traumatic distal radio-ulnar arthrosis: Long-term results and analysis of risks factors for revision surgery

IntroductionThe Sauvé-Kapandji (SKp) procedure is a frequently used surgery for the management of post-traumatic sequelae of the distal radio-ulnar joint (DRU). Series evaluating long-term outcomes and the risk of complications are rare. The main objective was to describe the long-term clinical and radiographic results after SKp performed in a post-traumatic context. The secondary objectives were to identify postoperative complications, surgical revisions, and their risk factors for occurrence. Our hypothesis was that although SKp confers good clinical results, identifiable risk factors for complications exist. Patients and methodsThis monocentric retrospective study included all patients for whom an SKp was performed in a post-traumatic context from 2008 to 2018. Pain, satisfaction, range of motion and pre- and postoperative radiographic measurements were recorded. All complications were sought and described, as well as surgical revisions. Several variables were analysed to identify risk factors for revision surgery after SKp: age, sex, initial traumatic mechanism, initial non-surgical or surgical treatment and type of surgery, time until revision surgery with SKp after the initial trauma. ResultsThirty-seven patients were included. At a median follow-up of 9.5 years (min 7.3–max 11.5), 22 patients (60%) had a VAS of 0. Range of motion was significantly improved for all the patients (p<0.001). Seventeen (46%) patients had a complication, including 5 (13.4%) cases of ossification, 4 (10.8%) cases of discomfort related to the hardware and 4 (10.8%) painful instability at the proximal ulnar stump. Thirteen (35%) patients required revision surgery. Two risk factors for revision surgery after SKp were found: time period between initial treatment and SKp of less than 7.2 months and an age of less than 53.5 years; the combination of the two factors having a sensitivity of 97.5 and a specificity of 56.7. ConclusionSKp in a post-traumatic context significantly improved range of motion and allowed pain control at long follow-up. Revision surgery seemed more frequent in patients under 53.5 years of age and when SKp was performed less than 7.2 months after the initial trauma. Level of evidenceIV, retrospective study.

Case Report of Modified Sauvé-Kapandji Technique Using Endobutton Suture in Secondary Treatment of Madelung Deformity

The Sauvé-Kapandji technique is considered a useful treatment option for distal radioulnar joint instability encountered in many conditions, such as Madelung deformity or in post-traumatic entities. However, post-operative instability of the proximal ulnar stump and radioulnar convergence may be symptomatic and is still a major concern. Despite proximal ulnar stump stabilization with various techniques, many patients still complain of pain and limitation of wrist movement. We report a case of a patient with Madelung disease treated initially by corrective radial and ulnar osteotomy, and then encountered a post-traumatic distal radioulnar joint instability. This condition was treated with a modified Sauvé-Kapandji procedure using a single endobutton suture, leading to good clinical and radiological results.

The outcome of Sauve Kapandji procedure on patient with DRUJ arthritis: A case report

BackgroundThe distal radioulnar joint (DRUJ) is frequently involved in inflammatory diseases, both de-generative and notably traumatic, resulting in pain, wrist motion and strength loss, and severe functional impairment. DRUJ dysfunction can be highly incapacitating. The Sauve-Kapandji (SK) procedure can be indicated to address multiple etiologies of DRUJ dysfunction.Case presentationA 54-year-old woman presented with pain and difficulty moving the left wrist. X-ray imaging revealed the union of the distal radius with the plate still in there with subluxation of the distal radioulnar joint after surgery in 2005. Afterwards, she underwent the Sauve-Kapandji procedure. Follow-ups were done at periodic intervals, and wrist physiotherapy was instituted. We evaluated the range of motion and the VAS score as well. The patient had acceptable motion after four weeks of evaluation.DiscussionThe SK method has been advocated as a treatment for DRUJ derangement because, un-like the Darrach surgery, it preserves the ulnar head at the wrist. As with the Darrach opera-tion, postoperative instability of the proximal ulnar stump or radioulnar convergence may occur despite the favourable clinical prognosis.ConclusionThe Sauve-Kapandji procedure could treat wrist pain and deformity in DRUJ arthritis. It gives a good result in two weeks, four weeks, twelve weeks, and twenty after the procedure. The peak time of recovery is four weeks after the procedure.

A Modified Extensor Carpi Ulnaris Tenodesis with the Sauvé-Kapandji Procedure.

Background: Since the Sauvé-Kapandji procedure was introduced in 1936, many modifications were created using dynamic stabilizer, such as the ECU (extensor carpi ulnaris), the FCU (flexor carpi ulnaris), pronator teres to solve proximal ulnar stump pain. We believe that this modification is also another option for distal ulnar stump instability. Methods: From January 1998 to February 2017, there were 13 patients received the Sauvé-Kapandji (S-K) procedure with tenodesis of the ECU to the carpus and interosseous membrane. The average age at operation was 52 years (range, 28 to 63 years). Four had traumatic arthritis (two from distal radial fracture malunion, two had instability of distal radioulnar joint from Essex-Lopresti injury), four had primary osteoarthritis of the distal radio-ulnar joint, two had rheumatoid arthritis, one had gouty arthritis, two had madelung deformity. The average follow-up was 30 months (range, 15 to 72 months). Results: Postoperative pronation/supination of the forearm had significantly improved with the exception of the wrist flexion/extension. After surgery, the mean radioulnar distance was narrowed from 11 mm to 9 mm, but no significant difference in 12 patients. All patients had improved in wrist pain, 10 patients had no pain and 3 patients with mild pain over the distal ulnar stump. The mean grip strength had significantly improved from 51% of the contralateral side to 75%. The lateral and stress X-ray films showed no instability of the distal ulnar stump after surgery. Conclusions: In conclusion, the modified S-K procedure using the tenodesis of ECU provides a multi-directional stability and is a reliable surgical procedure for distal radioulnar disorders.

Long-term results of Sauvé-Kapandji procedure.

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

Functional outcomes after modified Sauve-Kapandji arthrodesis for distal radioulnar joint dysfunction

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The distal radioulnar joint (DRUJ) dysfunction manifests as pain, weakness and reduced range of motion&lt;strong&gt;. &lt;/strong&gt;There are various treatments for DRUJ dysfunction. Modified Sauvé-Kapandji procedure involves arthrodesis of the distal radioulnar joint combined with the creation of a pseudarthrosis of the distal ulna to maintain forearm pronation and supination, and stabilization of proximal ulnar stump. This study was performed to evaluate the clinical outcomes of modified Sauve-Kapandji procedure for patients with DRUJ dysfunction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Fourteen patients with DRUJ dysfunction were treated by modified Sauve-Kapandji procedure and followed up for 2 years post-operatively. Functional assessment was evaluated according to modified mayo wrist score (MMWS) system and severity of pain by visual analog scale. Posteroanterior and lateral radiographs were used to assess fusion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;There was a significant improvement in VAS of wrist pain (p&amp;lt;0.001) and MMWS (p&amp;lt;0.001) at 2 years follow up. Excellent outcome was reported in 64.3% (n=9) patients. Radiographic fusion was seen in all 14 cases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The modified&lt;strong&gt; &lt;/strong&gt;Sauve-Kapandji procedure for DRUJ dysfunction is a safe and effective procedure with excellent radiological fusion and significant improvement in functional outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt; &lt;/strong&gt;&lt;/p&gt;

Treatment of Proximal Ulnar Stump after Darrach or Sauvé-Kapandji Procedure by Transfer of Insertion-Released Pronator Quadratus Pedicle.

Background: Treatment of the proximal ulnar stump with the Darrach or Sauvé-Kapandji (SK) procedure remains controversial. Ulnar wrist symptoms can result, and although many surgeons attribute these to ulnar stump instability, they can also be caused by radioulnar convergence or stump irritation. We present a novel surgical method for protecting the proximal ulnar stump and avoiding these complications. Methods: Our cases were five men and five women (mean age 72.0 years, range, 34-89). Mean follow-up duration was 41.7 months (range, 6-101 months). Radiological findings were osteoarthritis in five, rheumatoid arthritis of distal radioulnar joint in three, and ulnocarpal abutment syndrome in two. Pronator quadratus (PQ) was released from its insertion on the radius and transferred dorsally to cover the proximal ulnar stump. Postoperative ulnar wrist symptoms such as ulnar stump tenderness, forearm range of motion, and grip strength were compared with contralateral values. Dynamic radioulnar impingement was evaluated by Lee and Scheker's stress roentgenogram. Nine patients completed the Patient Rated Wrist Evaluation (PRWE) at final follow-up. Results: No patients reported ulnar wrist pain or tenderness at the proximal ulnar stump. Postoperative forearm range of motion recovered almost to contralateral values in cases without preoperative forearm contracture. In the two cases with contracture, postoperative pronation and supination recovered to more than their preoperative range. Grip strength averaged 86.4% (range, 66.7-103%) of the contralateral value at final follow-up. Lees and Scheker's stress roentgenogram revealed marked radioulnar impingement in one case, mild impingement in four cases and none in five, yet no patient complained of pain during the maneuver. The mean PRWE score was 34.7 points (range, 0-52.5 points). Conclusions: Insertion-released PQ pedicle transfer is an effective treatment option for the proximal ulnar stump after the Darrach or SK procedure.

Study of use of sauve- kapandji procedure in treating malunion of distal radius fractures

Malunion is a common delayed complication of distal radial fracture, if acceptable anatomic realignment of the distal end of radius has not been achieved during closed reduction. This leads to persistent radial shortening which leads to incongruency of the D.R.U.J., and positive ulnar variance. Dysfunction of the distal radioulnar joint leads to impaired function of the wrist joint. Various surgical techniques have been developed to treat instability of the DRUJ, including distal ulna resection, partial-resection with interposition arthroplasty, and the Sauve-Kapandji procedure. Methodology: In this study twenty patients with DRUJ dysfunction with impaired rotation of forearm due to malunion of distal radius fracture with positive ulnar variance were selected. Although the patients had complete union of the fracture, they were still having pain and functional limitations 5-12 months after fracture union. They were operated using the Sauve Kapandji procedure under aseptic precautions and adequate postop care was given along with physiotherapy. We studied 20 wrists in 20 patients (15 men and 5 women), with a mean age of 45 years (range, 28 to 65 years) at the time of the operation. The mean duration of follow-up was 12 months. We studied 7 cases of left and right side in 13 cases. At the final follow-up, out of 20 patients, 15 had excellent score, 3 had good score, 2 had fair score) In all patients the pseudoarthrosis gap of the ulna was well preserved and that the stability of the proximal ulnar stump also was preserved. Conclusion: Distal radius fractures(DRF) are very common in orthopedic practice and are often accompanied by instability of the distal radio ulnar joint (DRUJ). Before the era of operative surgery closed reduction with splinting was the treatment of choice. Now a variety of treatment options are available ; closed reduction with percutaneous pinning, open reduction internal fixation with plates and screws and external fixation. Although many procedur

Modified Sauve-Kapandji procedure with stabilisation of the proximal ulnar stump using extensor carpi ulnaris tendon for treating distal radioulnar joint disorders: A case series

Introduction: Distal radioulnar joint (DRUJ) disorders often lead to wrist pain, restriction of forearm rotation, and loss of grip strength. Several procedures are available to treat the disorder; however, there is no single procedure superior to another. In this study, we performed modified Sauve-Kapandji procedure with stabilisation of the proximal ulnar stump using extensor carpi ulnaris (ECU) tendon. Methods: We evaluated three patients with DRUJ disorders. We performed modified Sauve-Kapandji procedure with ECU tenodesis to all patients. Functional outcomes, including range of motion, grip power, and visual analogue scale, were recorded prospectively.Results: All patients had increased supination-pronation function with no reducing effect on grip power and no pain in the short term follow up. The benefits of the surgery were immediately shown following the day after the procedure. No complications occurred. Conclusion: The modified Sauve-Kapandji procedure with ECU tenodesis could be an option in the management of DRUJ disorders. Further larger studies with controls are required to investigate the safety and efficacy of such procedure.

Modified Sauvé-Kapandji procedure for the distal radioulnar joint disorders of osteoarthritis and rheumatoid arthritis.

The Sauvé-Kapandji (SK) procedure is one of several surgical options in the treatment of distal radioulnar disorders by osteoarthritis (OA) and rheumatoid arthritis (RA). While satisfactory postoperative clinical results were obtained in most cases, instability of the proximal ulnar stump and radioulnar convergence are the most common complications. Minami etal. have developed a modification of the SK procedure that maintains the transverse diameter of the distal radioulnar joint and stabilizes the proximal ulnar stump, using a half-slip of the extensor carpi ulnaris tendon. In this study, the modified SK procedure was performed on 83 patients with distal radioulnar disorders, due to OA and RA. We evaluated the clinical and radiographical postoperative results with an average follow-up period of 82.3 months. Post-operative extension of the wrist and pronation/supination of the forearm had significantly improved with the exception of wrist flexion. Postoperative x-rays showed no instability of the proximal ulnar stump in both coronal and lateral planes. However, breakage of the drilled hole at the proximal ulnar stump occurred in 10 cases, and of these, there was instability of the proximal ulnar stump in 5 cases. This modification is very simple and does not require extension of the surgical field. This paper concludes that the modified SK procedure is a safe and effective surgical intervention of distal radioulnar disorders from OA and RA.

"Quadrangular-construct" modification of Sauve-Kapandji procedure.

Background:Subluxation of ulna in distal radioulnar joint disorders causes pain on motion, loss of grip strength, and a restriction of forearm rotation. Several procedures have been described to salvage DRUJ disorders including the Darrach procedure, the matched distal ulnar resection, the hemiresection interposition arthroplasty (Bowers procedure) and the Sauve-Kapandji (S-K) procedure. All these procedures are associated with either loss of grip, pain over proximal ulnar stump or instability. We describe our modification of S-K procedure with good functional outcome.Materials and Methods:Twenty patients, 12 male and 8 female, underwent S-K procedure, with our modification, were included in this study. Patients were evaluated preoperatively, postoperatively, and on followup visits using Modified Mayo Wrist Score and wrist radiographs. Average followup period was 34.55 months (range 24-64 months).Results:Excellent results were found in one patient, good in 15 patients, and fair in four patients. Mean Modified Mayo Wrist Score improved from 32 to 79.75, which was statistically significant.Conclusions:Our modification of S-K procedure provides good functional outcome with stable ulnar stump and without significant procedure-related complications.

PROXIMAL ULNAR STUMP STABILITY AFTER USING THE PRONATOR QUADRATUS MUSCLE TRANSFER COMBINED WITH THE SUAVÉ-KAPANDJI PROCEDURE IN RHEUMATOID WRIST

The pronator quadratus muscle transfer combined with the Sauvé-Kapandji procedure was used to treat the distal radioulnar joint disorder in ten rheumatoid wrists for prevention against instability of the proximal ulnar stump. All patients were female with a mean age of 46.6 years. The mean follow-up time was 24.2 months. Postoperatively, supination increased in all patients with a mean of 50 degrees. Pain decreased significantly and none complained of prominence of the proximal ulnar stump in normal pronated position and during a tight grip. The wrist radiographs of both coronal and sagittal planes in normal and stress fisting views were used to evaluate the postoperative static and physiologic loaded stability of the proximal ulnar stump. It had shown this procedure provided good static proximal ulnar stump stability in both coronal and sagittal planes. However, in physiologic loaded condition, it was able to provide stability only in the sagittal plane.

Radiographic parameter analysis on modified sauvé-kapandji procedure.

Purpose The Sauvé-Kapandji (S-K) procedure is now an established treatment option for symptomatic distal radioulnar joint (DRUJ) dysfunction. However, for patients with poor bone quality (frequently as a result of advanced-stage rheumatoid arthritis [RA]), the conventional S-K procedure is difficult to perform without reducing the radioulnar diameter of the wrist, which may result in a loss of grip strength and pain over the proximal ulnar stump. The purpose of this study was to review the radiographic outcomes of patients who underwent a modified S-K procedure that involves rotating the resected ulnar segment 90 degrees and using it to bridge the gap between the sigmoid notch and the ulnar head. Methods The modified S-K procedure was performed in 29 wrists of 23 patients. Twenty-one patients had severe RA, while two had malunited radius fractures. The mean follow-up period was 43 months (range, 23 to 95). The radiographic evaluation included a measurement of the radioulnar width, the pseudarthrosis gap between the proximal and distal ulnar stump, the radioulnar distance, and the ulnar translation of the carpus. Results The radioulnar width of the wrist, pseudarthrosis gap, and radioulnar distance were well maintained throughout the period. A postoperative loss in the radioulnar width of the wrists appeared to correlate with a postoperative additional ulnar translocation of the carpus. Conclusion Narrowing of the radioulnar width of the wrist is a potential cause of progressive ulnar translocation of the carpus. The modified technique for the S-K procedure maintains the distal ulna in the proper position and provides sufficient ulnar support for the carpus. It is a useful reconstruction procedure in patients with severe RA with poor bone quality.

Die Arthrodese des distalen Radioulnargelenks mit gleichzeitiger Ellensegmentresektion nach Kapandji-Sauvé

The Kapandji-Sauvé procedure aims at improvement of rotation in the distal radioulnar joint and reduction of pain. Cases of ulnar impaction syndrome can also be corrected during the same procedure. The most important indication is painful und restricted forearm rotation after fracture of the distal radius combined with obsolete dislocation or destruction of the distal radioulnar joint. It is a salvage procedure and is contraindicated when reconstruction of the radioulnar joint or shortening of the ulna is possible. Further contraindications are rheumatic arthritis and osteoporosis. The Kapandji-Sauvé procedure creates a new distal rotatory joint due to distal radioulnar fusion and segmental resection of the distal ulna. Forearm cast including the wrist for 3-4weeks. Phyisiotherapy and intensive exercises of the fingers on postoperative day1. After removing the cast, careful rotation exercises are possible. In 75patients, the Kapandji-Sauvé procedure was performed between 1990 and 2003. Failure was observed in one patient with a bony regeneration between the resected ulnar segment. In 3 cases, a nonunion of the radioulnar joint was found. After revision with bone grafting, bony consolidation of the joint was identified in all cases. In 2 cases, there were problems with the proximal ulnar stump, whereby this was corrected in one case by resection of a ball-type callus. In the other case, painful ulna-snapping was reduced by shortening of the ulna. In earlier follow-up with 45patients and later long-turn follow-up, ranging from 3-12years, not only were significant improvement of forearm rotation and reduction of pain observed, but also good patient satisfaction was found.

A comparative study of the modified Sauvé–Kapandji procedure for rheumatoid wrist with and without stabilization of the proximal ulnar stump

We compared the clinical and radiological results of the modified Sauvé-Kapandji procedure for 41 of 86 operated rheumatoid wrists with (n=22) and without (n=19) stabilization of the proximal ulnar stump with a slip of half the extensor carpi ulnaris tendon. Gender, age, and follow-up period were similar in the two groups. We found no difference clinically or on radiographs between the two groups other than better early postoperative pain relief in those stabilized. Stabilization of the proximal ulnar stump may not be necessary in the modified Sauvé-Kapandji procedure for rheumatoid wrists.

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

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.

Salvage of the Unstable Sauvé-Kapandji Procedure

The Sauvé-Kapandji procedure has been commonly performed in the setting of posttraumatic osteoarthritis of the distal radioulnar joint. A recognized complication is instability of the proximal ulnar stump, which may occur in up to 33% of cases. Salvage of the failed Sauvé-Kapandji procedure in this setting is difficult and can sometimes involve sacrifice of forearm rotation. We report the results of 3 cases of a new salvage procedure in this setting. The radioulnar pseudarthrosis was taken down; ulnar continuity was restored with an intercalary graft; and forearm rotation was restored with matched hemiresection and interposition arthroplasty at the site of previous radioulnar fusion. Postoperatively, all patients achieved good forearm rotation (mean supination, 60 degrees; mean pronation, 65 degrees), had no symptoms of instability, and were satisfied with the results of the procedure. Disabilities of the Arm, Shoulder and Hand scores improved from preoperative mean of 55 to postoperative mean of 18.

Symptoms and Radiographic Findings in the Proximal and Distal Ulnar Stumps After the Sauvé-Kapandji Procedure for Treatment of Chronic Derangement of the Distal Radioulnar Joint

We analyzed correlations between symptoms and radiographic findings with respect to the proximal and distal ulnar stumps after the Sauvé-Kapandji procedure for treating chronic derangement of the distal radioulnar joint. A total of 26 patients were studied (13 men, 13 women) with a mean age of 46 years at examination. Clinical assessment included elicitation of postoperative symptoms related to the proximal and distal ulnar stumps. In the radiographic study the radioulnar distance in the neutral wrist position and the presence or absence of scalloping at the radius were determined from posteroanterior (PA) views. The total mobility distance of the proximal ulnar stump was measured on the PA and lateral views while the wrist moved from radial to ulnar deviation or from extension to flexion. Eleven patients complained of tenderness over the distal ulnar stump and 5 patients felt discomfort around the proximal ulnar stump during forearm rotation. The postoperative radioulnar distance in patients with tenderness was significantly smaller than in the group without tenderness. Scalloping at the radius was shown in 9 patients but it was not related to the radioulnar distance. The total mobility distance of the proximal ulnar stump on the PA view was significantly greater in patients with tenderness than in those without, and it also was significantly greater in patients with scalloping than in those without. The total mobility distance on the lateral view was significantly greater in the group with discomfort than in the group without discomfort. The radioulnar distance was related to tenderness over the distal ulnar stump but not to the scalloping. Tenderness and scalloping each were related to radioulnar instability of the proximal ulnar stump. Discomfort around the proximal ulnar stump was related to dorsovolar instability of the stump. Prognostic, Level IV.

Stabilization of the Proximal Ulnar Stump in the Sauvé-Kapandji Procedure by Using the Extensor Carpi Ulnaris Tendon: Long-Term Follow-Up Studies

The Sauvé-Kapandji procedure is considered a useful treatment option for distal radioulnar disorders. Postoperative instability of the proximal ulnar stump and radioulnar convergence, however, may be symptomatic. We modified the Sauvé-Kapandji procedure by stabilizing the proximal ulnar stump with a half-slip of the extensor carpi ulnaris tendon. We previously reported on 13 patients with this procedure at an average follow-up period of 35 months; the patients had satisfactory clinical results and improved stability of the proximal ulnar stump as shown by x-ray examination. In this article we address the question of whether those clinical and radiographic results noted at an average follow-up period of 35 months after surgery were maintained at later follow-up examinations. We re-examined 12 of the 13 original patients and compared their initial follow-up results with their current results after an average follow-up period of 95 months. The results of this series after 95 months of follow-up evaluation were similar to the results at 35 months. The results presented in this article suggest that the clinical radiographic results at the 35-month follow-up examination were maintained in the long-term 95-month follow-up evaluation despite the finding that the hole in the proximal ulnar stump had broken in 3 wrists at follow-up examination. Therapeutic, Level IV.