Modified Sauve-Kapandji Procedure for Disorders of the Distal Radioulnar Joint in Patients with Rheumatoid Arthritis

Author(s): Fujita S, Masada K, et.al.

Source: The Journal of Bone and Joint Surgery 87-A: 134-139, 2005.

Summary:

This article is a retrospective review of 56 patients (66 wrists) with rheumatoid arthritis who underwent a modified Sauve-Kapandji procedure for disorders of the distal radioulnar joint.  The procedure involved an osteotomy 3 cm proximal to the distal end of the ulna with an oscillating saw.  The pronator quadratus muscle was partially interposed at the osteotomy site.  A 10 mm diameter hole is created at the sigmoid notch of the radius with power drills and curettes.  The ulna was rotated 90 degrees and inserted into the hole in the radius and fixed with a cancellous screw.  The periosteum and capsule were closed over the end of the bone and a short arm cast is applied for 3 weeks.  The mean duration of follow-up was 48 months.

Osseous union was achieved in all cases at an average of 6.2 weeks.  Local resorption of the graft bone was seen in 6 cases around the screw head.  New bone formation was noted in the gap between the two ulnar fragments in 8 patients but did not appear to affect forearm rotation.  The visual analog scores decreased from a mean of 8.2 before the operation to 1.0 after the operation.  The total arc of wrist flexion and extension decreased by 6 degrees after the operation.  The total arc of forearm rotation increased by 23 degrees.  Instability of the distal ulnar stump was found in all patients although most were not troubled by symptoms and experienced only minor if any discomfort.  Osseous ankylosis between the lunate and ulnar graft occurred in 7 patients.  An ankylosis through the entire wrist occurred in 1 patient.

This article reviews an interesting modification of the Sauve-Kapandji procedure with the hopes of enhancing osseous fixation.  In this study, all 66 wrists achieved osseous union despite presumably having poor bone stock that may have resulted in a delayed or incomplete fusion.  There was significant improvement in pain as well as wrist and forearm range of motion.  This modification appears to be a reasonable alternative to the classic Sauve-Kapandji procedure.  The overall benefit of the Sauve-Kapandji procedure over a distal ulnar excision alone was not evaluated.

 

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Journal of Bone and Joint Surgery