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Suzuki T, Momma D, Inoue N, Kondo E, Matsui Y, Iwasaki N. Effect of the Sauvé-Kapandji method on the wrist contact surface for distal radial ulnar joint disorders. BMC Musculoskelet Disord 2024; 25:532. [PMID: 38987711 PMCID: PMC11238469 DOI: 10.1186/s12891-024-07652-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 07/01/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND The Sauvé-Kapandji (S-K) method is a surgical procedure performed for chronic deformities of the distal radial ulnar joint (DRUJ). Changes to the joint contact surface from pre- to postoperatively under physiological in vivo conditions have not yet been determined for this useful treatment. The aim of the present study was therefore to compare the articular contact area of the wrist joint between before and after the S-K method for DRUJ disorders. METHODS The SK method was performed for 15 patients with DRUJ osteoarthritis and ulnar impaction syndrome. We calculated the Mayo Wrist Score as the patient's clinical findings and created 3-dimensional bone models of cases in which the S-K method was performed and calculated the contact area and shift in the center of the contact area using customized software. RESULTS The Mean modified Mayo Wrist Score improved significantly from 60.3 preoperatively to 80.3 postoperatively (P < 0.01). Scaphoid contact area to the radius increased significantly from 112.6 ± 37.0 mm2 preoperatively to 127.5 ± 27.8 mm2 postoperatively (P = 0.03). Lunate contact area to radius-ulna was 121.3 ± 43.3 mm2 preoperatively and 112.5 ± 37.6 mm2 postoperatively, but this decrease was not significant (P = 0.38). Contact area ratio of scaphoid to lunate increased significantly from 1.01 ± 0.4 preoperatively to 1.20 ± 0.3 postoperatively (P = 0.02). Postoperative translations of the center of the scaphoid and lunate contact areas were decomposed into ulnar and proximal directions. Ulnar and proximal translation distances of the scaphoid contact area were 0.8 ± 1.7 mm and 0.4 ± 0.6 mm, respectively, and those of the lunate contact area were 1.1 ± 1.7 mm and 0.4 ± 1.1 mm, respectively. This study revealed changes in wrist contact area and center of the contact area before and after the S-K method. CONCLUSION These results may accurately indicate changes in wrist joint contact area from pre- to postoperatively using the S-K method for patients with DRUJ disorder. Evaluation of changes in contact area due to bone surface modeling of the wrist joint using 3DCT images may be useful in considering surgical methods.
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Affiliation(s)
- Tomoaki Suzuki
- Department of Orthopaedic Surgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Daisuke Momma
- Center for Sports Medicine, Hokkaido University Hospital, Sapporo, Hokkaido, Japan.
| | - Nozomu Inoue
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, USA
| | - Eiji Kondo
- Center for Sports Medicine, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Yuichiro Matsui
- Department of Orthopaedic Surgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
- Department of General Dentistry, Faculty of Dental Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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Kapoor L, Kumar VS, Ansari MT, Khan SA. Ulnar Buttress Arthroplasty without Ulnar Stump Stabilization for Giant Cell Tumor of Distal Ulna. J Wrist Surg 2024; 13:215-221. [PMID: 38808189 PMCID: PMC11129884 DOI: 10.1055/s-0043-1768925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/03/2023] [Indexed: 05/30/2024]
Abstract
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.
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Affiliation(s)
- Love Kapoor
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Venkatesan S. Kumar
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Mohammed T. Ansari
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Shah A. Khan
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
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Deneuville M, Germon C, Sturbois-Nachef N, Chazard E, Chantelot C, Saab M. The Sauvé-Kapandji procedure for post-traumatic distal radio-ulnar arthrosis: Long-term results and analysis of risks factors for revision surgery. Orthop Traumatol Surg Res 2024; 110:103562. [PMID: 36702297 DOI: 10.1016/j.otsr.2023.103562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 09/29/2022] [Accepted: 11/16/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION The 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 METHODS This 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. RESULTS Thirty-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. CONCLUSION SKp 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 EVIDENCE IV, retrospective study.
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Affiliation(s)
- Marine Deneuville
- Service de traumatologie, Hôpital Roger-Salengro, Centre hospitalier régional universitaire, avenue Emile-Laine, 59037 Lille, France
| | - Charlotte Germon
- Service d'orthopédie-traumatologie, Centre hospitalier de Seclin, rue d'Apolda, 59113 Seclin, France.
| | - Nadine Sturbois-Nachef
- Service de chirurgie orthopédique 1, Hôpital Roger-Salengro, Centre hospitalier régional universitaire, avenue Emile-Laine, 59037 Lille, France
| | - Emmanuel Chazard
- Service méthodologie, biostatistique, gestion de données et archives, CHU de Lille, rue du Professeur-Laguesse, 59000 Lille, France
| | - Christophe Chantelot
- Service de traumatologie, Hôpital Roger-Salengro, Centre hospitalier régional universitaire, avenue Emile-Laine, 59037 Lille, France
| | - Marc Saab
- Service de chirurgie orthopédique 1, Hôpital Roger-Salengro, Centre hospitalier régional universitaire, avenue Emile-Laine, 59037 Lille, France
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Debeij GP, Hannemann PFW, Ten Bosch JA. Long-term outcome of the Sauvé-Kapandji procedure in patients with post-traumatic distal radioulnar joint disorders. J Hand Surg Eur Vol 2024:17531934241242678. [PMID: 38534125 DOI: 10.1177/17531934241242678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
The aims of this study were to retrospectively assess the occurrence of complications or need for secondary wrist procedures after the Sauvé-Kapandji procedure, and to prospectively assess patient-reported outcomes at long-term follow-up. All patients treated with the Sauvé-Kapandji procedure in our tertiary referral hospital between January 2008 and September 2021 were identified and contacted to complete the Quick Disabilities of the Arm, Shoulder, and Hand and the Patient-Rated Wrist/Hand Evaluation outcome measures. In total, 30 patients, with a median follow-up of 82 months, were included in this study. Complications occurred in 6 of 30 patients, which resulted in six secondary wrist procedures. Mean Quick Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist/Hand Evaluation scores were 30.1 and 33.6, respectively. We conclude that in respect of long-term outcomes, the Sauvé-Kapandji procedure can still be deemed to be a useful procedure, especially in patients with few other reconstructive options.Level of evidence: IV.
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Affiliation(s)
- Gijs P Debeij
- Department of Surgery, Division of Trauma Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Pascal F W Hannemann
- Department of Surgery, Division of Trauma Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Jan A Ten Bosch
- Department of Surgery, Division of Trauma Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
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Ohara T, Yamazaki T, Matsuura Y, Suzuki T, Ohtori S. Radioulnar Instability and Ulnar Stump Stabilization in Distal Radio Ulnar Joint Arthritis: A Cadaver Study. Cureus 2023; 15:e41163. [PMID: 37525807 PMCID: PMC10387169 DOI: 10.7759/cureus.41163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Salvage procedures for distal radioulnar joint (DRUJ) arthritis, like the Darrach or Sauvé-Kapandji (S-K) procedures, often result in extensor tendon ruptures at the ulnar stump. Radioulnar instability is considered the underlying cause and stump stabilization techniques are employed. This study investigated radioulnar instability, extensor tendon irritation, and the effectiveness of stump stabilization techniques following salvage procedures. METHODS Six upper limbs from three cadavers were used. Forearm rotation was measured using magnetic position sensors to assess radial movement. The Darrach procedure was performed on two limbs, comparing radial motion ranges for different ulnar osteotomy positions. The risk of tendon rupture was assessed with applied weight. The S-K procedure was performed on four limbs, evaluating stump stabilization techniques and radial movement distance underweight. RESULTS Proximal osteotomy positions increased radial motion range. Extensor tendon irritation occurred when the load was applied to the volar and ulnar sides, particularly with a pronated forearm. Stump stabilization techniques did not significantly contribute to ulnar stump stabilization. CONCLUSIONS Proximal ulnar osteotomy positions in DRUJ salvage procedures led to increased radioulnar instability and potential complications. Load application on the volar and ulnar sides, especially in a pronated forearm, increased the risk of tendon rupture. Stump stabilization techniques showed limited utility in stabilizing the ulnar stump or reducing complications. These findings can inform strategies for minimizing complications in DRUJ salvage procedures.
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Affiliation(s)
- Takeru Ohara
- Orthopedic Surgery, Chiba University's Graduate School of Medicine, Chiba, JPN
| | - Takahiro Yamazaki
- Orthopedic Surgery, Chiba University's Graduate School of Medicine, Chiba, JPN
| | - Yusuke Matsuura
- Orthopedic Surgery, Chiba University's Graduate School of Medicine, Chiba, JPN
| | - Takane Suzuki
- Orthopedic Surgery, Chiba University's Graduate School of Medicine, Chiba, JPN
| | - Seiji Ohtori
- Orthopaedics, Chiba University Hospital, Chiba, JPN
- Orthopedic Surgery, Chiba University's Graduate School of Medicine, Chiba, JPN
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Katt BM, Tawfik A, Zingas N, Sirch F, Beredjiklian PK, Fletcher D. Distal Radioulnar Joint Osteoarthritis: An Update on Treatment Options. J Hand Microsurg 2023; 15:5-12. [PMID: 36761052 PMCID: PMC9904983 DOI: 10.1055/s-0041-1725222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
The distal radioulnar joint (DRUJ), the articulation between the sigmoid notch of the radius and the distal ulna, plays a pivotal role in stability and load bearing and allows for pronation and supination of the forearm. Osteoarthritis (OA) of the DRUJ commonly occurs due to distal radius trauma but may also be the result of conditions such as joint instability, septic arthritis, or primary OA. It is initially managed with conservative therapy, but surgery is often considered when nonoperative methods fail. The surgical approaches available to treat this pathology have grown over the years. The procedures have generally favorable outcomes, each with their own unique complications and considerations. This paper comprises a review of the outcomes and complications for the different procedures commonly used to surgically treat DRUJ OA.
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Affiliation(s)
- Brian M. Katt
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania,, United States
| | - Amr Tawfik
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania,, United States
| | - Nicholas Zingas
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Francis Sirch
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania,, United States
| | - Pedro K. Beredjiklian
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania,, United States
| | - Daniel Fletcher
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania,, United States
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Munaretto N, Aibinder W, Moran S, Rizzo M. Sauve-Kapandji Remains a Viable Option for Distal Radioulnar Joint Dysfunction. Hand (N Y) 2022; 17:963-968. [PMID: 33225741 PMCID: PMC9465792 DOI: 10.1177/1558944720966725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Dysfunction of the distal radioulnar joint (DRUJ) can be significantly debilitating. The Sauve-Kapandji (S-K) procedure can be indicated to address multiple etiologies of DRUJ dysfunction. The purpose of this study was to review our institution's results performing the S-K procedure for DRUJ dysfunction in terms of clinical and radiographic outcomes, as well as complications and reoperations. METHODS A retrospective review of S-K procedures performed at 2 institutions between 1998 and 2017 with a minimum of 1-year follow-up was performed. Preoperative and postoperative visual analog scale (VAS) pain, grip strength, and wrist range of motion were reviewed. Radiographs were reviewed for DRUJ healing, carpal translation, and radiocarpal degenerative changes. RESULTS The cohort included 35 patients. The mean age was 51 years. The mean follow-up was 49.5 months. The postoperative range of motion was unchanged in regard to pronation, supination, and wrist extension. There was a decrease in wrist flexion from 43 degrees to 34 degrees. Successful union was noted in 100% of the wrists. There was 1 case (2.8%) of progressive ulnar translation and 4 major complications (11.3%). CONCLUSION The S-K procedure has several theoretical benefits compared to other procedures for DRUJ dysfunction with results of this study demonstrating excellent pain relief, improved postoperative grip strength, retained wrist pronation, supination, and extension, high rate of successful arthrodesis and low rate of major complications. LEVEL OF EVIDENCE Level IV.
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Liu H, Xu S, Huang Z, Lv Y, Chen B, Lin X, Liu J, Sang L. Application of Suspension Fixation with Button Plates for Patients with Distal Radioulnar Joint Dislocation: A Case Series. Orthop Surg 2021; 13:2061-2069. [PMID: 34596957 PMCID: PMC8528975 DOI: 10.1111/os.12932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/05/2020] [Accepted: 12/20/2020] [Indexed: 11/30/2022] Open
Abstract
Objective The aim of the present study was to assess the effect of suspension fixation with button plates on the reconstruction of the distal radioulnar joint dislocation (DRUJ). Methods This was a case series of six patients (two men and four women) who underwent suspension fixation with button plates for DRUJ dislocation between January 2015 and May 2017. Physical examination, radiography, MRI, functional activity of the wrist joint, grip strength of the wrist joint, Garland–Werley wrist score, Mayo wrist score, and visual analog scale (VAS) score were used to evaluate the effect of this procedure. All patients were followed up every 3 months. The evaluation time point was 12 months after the operation. Comparisons of the functional indexes of wrist function before and after the operation were performed using paired statistical tests. Results The mean range of motion of the affected limb was 70° at forearm pronation and 75° at forearm supination. The subjective assessments and tests of the motor function of the wrist showed improvement after surgery. The Garland–Werley wrist score was 13.50 ± 2.66 preoperatively, the Mayo wrist score was 56.67 ± 18.35, and the VAS score was 4.83 ± 1.17. The Garland–Werley wrist score was 2.83 ± 1.33 postoperatively at 12 months, the Mayo wrist score was 87.5 ± 6.89, and the VAS score was 0.50 ± 0.55. At 12 months, the Garland–Werley wrist score, the Mayo wrist score, and the VAS score showed significant improvements when compared with those before surgery (P = 0.000, P = 0.003, and P = 0.000, respectively). Radiographic examination revealed that the internal fixation device was in place, and no dislocation of the DRUJ could be observed. None of the patients had internal fixation device removal or re‐dislocation of the DRUJ. None of the patients had re‐dislocation of the DRUJ. No secondary ulnar or radial fractures and nerve injury were reported during and after surgery. No tumor recurrence was observed in patients with giant cell tumors of the tendon sheath. No loosening and displacement of screws were reported. Conclusion The new method of suspension fixation with button plates for the surgical reconstruction of a DRUJ dislocation is simple, with minimal trauma, and maintains the stability of the DRUJ without the need for intra‐articular or extra‐articular reconstruction of the ligament. Furthermore, it allows early functional exercise and achieves satisfactory postoperative functional recovery.
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Affiliation(s)
- Hongliang Liu
- Department of Orthopaedics, The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Shuchai Xu
- Department of Orthopaedics, The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Zexin Huang
- Department of Orthopaedics, The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Yang Lv
- Department of Orthopaedics, The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Bojian Chen
- Department of Orthopaedics, The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Xiaodong Lin
- Department of Orthopaedics, The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Jun Liu
- Department of Orthopaedics, The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Lili Sang
- Division of Joint Surgery, Department of Orthopaedic Surgery, The Affiliated Zhongshan Hospital of Guangzhou University of Traditional Chinese Medicine, Zhongshan, China
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Comparison of subjective outcomes of Darrach and Sauvé-Kapandji procedures at a minimum 2 years' follow-up. Orthop Traumatol Surg Res 2021; 107:102974. [PMID: 34087500 DOI: 10.1016/j.otsr.2021.102974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 10/09/2020] [Accepted: 11/04/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION In distal radioulnar joint pathology, the literature regularly recommends reserving the Sauvé-Kapandji (SK) procedure to young patients and heavy manual workers, and the Darrach (D) procedure to older patients and rheumatic wrists. However, the SK procedure is more technically demanding and requires more proximal resection of the ulna, with greater risk of instability in the ulnar stump. The aim of the present study was to determine whether the SK procedure really does show superiority. HYPOTHESIS Subjective results are no better after the SK than the D procedure. MATERIAL AND METHODS Seventy of the 101 operated cases (70 patients: 40 female, 30 male; mean age at surgery, 50.2 years [range, 16.4-87.2 years]) were assessed, at a minimum 24 months. Group D comprised 44 wrists, and group SK 26. Assessment was conducted by telephone interview for pain, ranges of flexion-extension and pronation-supination, strength, stump stability and satisfaction, and by mail for the QuickDASH questionnaire. Mean follow-up was 8.2 years (range, 25 months to 17 years). RESULTS The surgical revision rate was significantly higher in SK (p=0.003). Results were comparable between groups for pain, strength, range of motion and satisfaction. Mean QuickDASH score was 45.5 in group D and 26.5 in group SK. Age-matched comparison found no significant differences on endpoints. DISCUSSION Subjective results after the SK procedure showed no superiority over the D procedure, despite group D patients having twice the rate of heavy manual work and sport activities. This non-difference casts doubt on the need to reserve the D procedure to elderly patients and the SK procedure to young patients and heavy manual workers, especially as the latter is more technically demanding and is associated with a higher rate of surgical revision. LEVEL OF EVIDENCE IV; retrospective study.
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Reissner L, Schweizer A, Unterfrauner I, Estermann L, Nagy L. Long-term results of Sauvé-Kapandji procedure. J Hand Surg Eur Vol 2021; 46:626-631. [PMID: 33844599 PMCID: PMC8226425 DOI: 10.1177/17531934211004459] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/23/2021] [Accepted: 03/03/2021] [Indexed: 02/03/2023]
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.
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Affiliation(s)
- Lisa Reissner
- Department of Orthopedics, Hand Surgery Division, Balgrist
University Hospital Zurich, Switzerland
| | - Andreas Schweizer
- Department of Orthopedics, Hand Surgery Division, Balgrist
University Hospital Zurich, Switzerland
| | - Ines Unterfrauner
- Department of Orthopedics, Hand Surgery Division, Balgrist
University Hospital Zurich, Switzerland
| | - Lea Estermann
- Department of Orthopedics, Hand Surgery Division, Balgrist
University Hospital Zurich, Switzerland
| | - Ladislav Nagy
- Department of Orthopedics, Hand Surgery Division, Balgrist
University Hospital Zurich, Switzerland
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Yayac M, Padua FG, Banner L, Seigerman DA, Beredjiklian PK, Aita DJ, Fletcher D. Treatment Outcomes in Patients Undergoing Surgical Treatment for Arthritis of the Distal Radioulnar Joint. J Wrist Surg 2020; 9:230-234. [PMID: 32509428 PMCID: PMC7263868 DOI: 10.1055/s-0040-1702200] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 01/07/2020] [Indexed: 10/24/2022]
Abstract
Objective Surgical treatment options for distal radioulnar joint (DRUJ) arthritis include distal ulnar resection (DUR), DRUJ arthrodesis, and ulnar head replacement. Ulnar convergence leading to persistent pain and clicking is a relatively common complication of complete DUR and DRUJ arthrodesis with distal ulnar segment resection (DRUJA). This led to the development of the distal ulna hemiresection (DUHR) and distal ulnar stump stabilization techniques to reduce the risk of this complication. Patients may experience incomplete relief of pain and limited range of motion (ROM) with these procedures. We hypothesized that there would be no differences in outcomes between the treatment groups, but patients undergoing DUHR, tendon interposition, or distal ulnar stump stabilization would be at lower risk of complications. Methods Records were retrospectively reviewed for 121 patients undergoing DRUJ procedures between 2000 and 2018 at a single institution to collect patient demographics, surgical details, preoperative diagnosis, and outcomes including complications, revision procedures, ROM, pain, and swelling. Patients were grouped for analysis by procedure type: DUR (Darrach procedure), DUHR (Bowers procedure), and DRUJA (Sauve-Kapandji procedure). Continuous variables were compared using an analysis of variance test and categorical variables using the Freeman-Halton extension of the Fisher's exact test. A multivariate logistic regression analysis was performed to identify significant predictors of outcomes. Results Seventy-three patients underwent a DUR procedure, while 33 patients underwent a DUHR procedure and 11 underwent a DRUJA procedure. Mean follow-up was 70.6 months. Patients undergoing DRUJA were significantly younger than those undergoing DUR or DUHR procedure (42.4 vs. 60.0 vs. 62.1, p < 0.001). No significant differences between groups were demonstrated in measured outcomes. Posttraumatic arthritis was the most common preoperative diagnosis (43.4%). Persistent pain was the most common negative outcome (25.6%) followed by limited ROM (19.7%). Five patients (4.3%) suffered postoperative complications, most common being rupture of extensor tendons. Five patients (4.3%) underwent revision procedures. Body mass index (BMI) was a significant predictor of persistent pain (odds ratio = 1.09, p = 0.031). Conclusion The results of our study suggest that outcomes are equivalent between the three distinct treatment groups. Despite the potential benefits, hemiresection, tendon interposition, and distal stump stabilization had no significant effect on outcomes in this study. More than a quarter (25.6%) of patients undergoing DRUJ procedures experience persistent pain postoperatively, while one-fifth (19.7%) experienced limited ROM. Patients with higher BMI are at a significantly greater risk of experiencing persistent postoperative pain. Level of Evidence This is a Level III, retrospective comparative study.
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Affiliation(s)
- Michael Yayac
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Fortunato G. Padua
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lauren Banner
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Daniel A. Seigerman
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Pedro K. Beredjiklian
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Daren J. Aita
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Daniel Fletcher
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
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Functional Outcomes After Sauve-Kapandji Arthrodesis. J Hand Surg Am 2020; 45:408-416. [PMID: 31948706 DOI: 10.1016/j.jhsa.2019.11.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 09/30/2019] [Accepted: 11/22/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The Sauve-Kapandji procedure (SK) combines a distal radioulnar joint (DRUJ) arthrodesis with the creation of an ulnar pseudarthrosis for the salvage of DRUJ instability or arthritis. Despite several published case series, there are limited data on postoperative functional outcomes. This study evaluates patient-reported outcomes of SK using a validated functional outcomes scale. METHODS We performed a retrospective review of patients who underwent SK in 2 health care systems over 10 years (2008-2018). Preoperative and postoperative range of motion, Quick-Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores, and wrist plain film radiographic measurements were recorded. Preoperative and postoperative outcomes analyses and subgroup comparisons were performed. RESULTS We included 57 patients in the study. Surgical indications included posttraumatic DRUJ arthritis (n = 35), rheumatoid arthritis (n = 10), degenerative DRUJ arthritis (n = 7), Madelung deformity (n = 3), psoriatic arthritis (n = 1), and giant cell tumor of bone (n = 1). During the first postoperative year, QuickDASH scores decreased from a mean of 52 before surgery to 28 at 12 months. The QuickDASH scores at final follow-up demonstrated significant improvement in patients with osteoarthritis and inflammatory arthritis. Supination significantly improved after surgery, from 48° to 74°, whereas wrist flexion, wrist extension, and pronation remained unchanged. Radiographically, significant postoperative decreases were seen in ulnar variance and McMurtry's translation index. The postoperative complication rate was 21%, including revision osteotomy in 4 patients (7.0%) and hardware removal in 4 patients (7.0%). No DRUJ nonunions were seen. CONCLUSIONS The Sauve-Kapandji procedure for DRUJ salvage significantly improved patient-reported outcomes after 1 year and significantly improved supination. Similar functional improvements after SK were seen in both osteoarthritis and inflammatory arthritis. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Fok MWM, Fernandez DL, van Schoonhoven J. Midterm Outcomes of the Use of a Spherical Ulnar Head Prosthesis for Failed Sauvé-Kapandji Procedures. J Hand Surg Am 2019; 44:66.e1-66.e9. [PMID: 29934080 DOI: 10.1016/j.jhsa.2018.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 04/01/2018] [Accepted: 05/01/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The use of a spherical ulnar head prosthesis (UHP) for the treatment of symptomatic radioulnar convergence after Sauvé-Kapandji (SK) procedure has shown promising results in the short term. This study aims to evaluate the midterm outcome of the original cohort of patients treated with this technique. METHODS Seventeen patients with unstable ulnar stumps confirmed both clinically and radiographically were studied. The etiology for the initial SK procedure included posttraumatic distal radioulnar joint (DRUJ) incongruity, primary DRUJ arthrosis, and dysplastic DRUJ. Fourteen of the 17 patients had a minimum of 2, and a maximum of 6, operations prior to having a spherical UHP. All patients suffered from severe pain with difficulty in performing work and daily activities. Ceramic UHP was used for all patients, except 2 in whom a cobalt chrome head was used. RESULTS The average follow-up was 6 years (range, 4-17 years). A marked reduction in pain was observed with 11 patients reporting that they remained pain free. The range of motion of the wrist and power grip was maintained and showed a statistically significant improvement at the late follow-up. The Disabilities of the Arm, Shoulder, and Hand score also significantly improved from 77 to 41. There were no signs of prosthetic loosening at the midterm follow-up. The 2 patients with cobalt chrome prostheses had pain and osteolysis requiring revision to total DRUJ prosthesis. Two patients with dorsal prosthetic subluxation were successfully treated with distal radial osteotomy. CONCLUSIONS The midterm results of ceramic spherical UHP for failed SK procedures in this small patient series are encouraging. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
| | - Diego L Fernandez
- Department of Orthopaedic Surgery, Lindenhof Hospital, Bern, Switzerland
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Functional outcomes after the Sauvé-Kapandji procedure for distal radio-ulnar post-traumatic instability: a case-control comparison of three different operative methods of stabilization of the ulnar stump. INTERNATIONAL ORTHOPAEDICS 2018; 42:2173-2179. [PMID: 29955946 DOI: 10.1007/s00264-018-4042-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 06/19/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE This study was performed to elucidate the cause of proximal ulnar stump pain by comparing the clinical results and radiographic changes among three treatment groups involving different Sauvé-Kapandji procedures. METHODS Thirty-seven patients (38 wrists) with distal radioulnar joint disorders followed up for ≥ six months post-operatively were investigated. Patients were treated by one of three Sauvé-Kapandji procedures. In group A (13 wrists), the original Sauvé-Kapandji procedure was performed. Groups B (13 wrists) and C (12 wrists) involved different modified Sauvé-Kapandji procedures with stabilization of the proximal ulnar stump using the extensor carpi ulnaris tendon. At the final examination, we evaluated wrist pain, proximal ulnar stump pain, the ranges of forearm pronation/supination, grip strength, the grip strength ratio between the affected and unaffected sides, and the clinical evaluation score. Standard posteroanterior and lateral radiographs during rest and during maximal gripping were taken for each patient at the final examination, and radiographic parameters were measured. RESULTS Although significant differences in the frequency of ulnar stump pain were observed between group A and group B or C, no significant differences in wrist pain or the clinical evaluation score were observed. Moreover, no differences in the radiographic changes were noted among the three procedures. CONCLUSION These findings suggest that proximal ulnar stump pain may be caused not by radial or dorsal deviation of the proximal ulnar stump but by other dynamic factors.
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Wakasugi T, Shirasaka R, Fujita K. Insufficiency Fracture of the Radial Diaphysis Following a Sauve-Kapandji Procedure for Osteoarthritis of the Distal Radioulnar Joint: A Case Report. J Hand Surg Asian Pac Vol 2018; 23:270-273. [PMID: 29734895 DOI: 10.1142/s2424835518720153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The Sauve-Kapandji (SK) procedure for distal radioulnar joint osteoarthritis have complications including pain over the proximal ulnar stump, nonunion of the fused distal radioulnar joint, and less frequently, insufficiency fracture of the distal radius. We report a case of insufficiency fracture of the radial diaphysis as a rare complication of the SK procedure.
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Affiliation(s)
- Takuma Wakasugi
- * Department of Orthopaedic Surgery, Tsuchiura Kyodo Hospital, Ibaraki, Japan
| | - Ritsuro Shirasaka
- * Department of Orthopaedic Surgery, Tsuchiura Kyodo Hospital, Ibaraki, Japan
| | - Koji Fujita
- † Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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Minami A, Kamiya Y, Tojo Y, Harmon SM, Suda K. Modified Sauvé-Kapandji procedure for the distal radioulnar joint disorders of osteoarthritis and rheumatoid arthritis. J Orthop Sci 2018; 23:516-520. [PMID: 29551357 DOI: 10.1016/j.jos.2018.01.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 01/09/2018] [Accepted: 01/19/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND 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 et al. 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. MATERIALS AND METHODS We evaluated the clinical and radiographical postoperative results with an average follow-up period of 82.3 months. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Akio Minami
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai, Japan.
| | - Yukinobu Kamiya
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai, Japan
| | - Yasuaki Tojo
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai, Japan
| | | | - Kota Suda
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai, Japan
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Tomori Y, Sawaizumi T, Nanno M, Takai S. Radiological comparison of conventional versus modified sauvé-kapandji procedure with stabilization of the proximal ulnar stump using the extensor carpi ulnaris tendon: A retrospective case-control study. Medicine (Baltimore) 2018. [PMID: 29538205 PMCID: PMC5882408 DOI: 10.1097/md.0000000000010118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The Sauvé-Kapandji procedure is a reliable option for patients with various disorders of the distal radioulnar joint (DRUJ). However, postoperative pain over the proximal ulnar stump frequently develops during forearm rotation or when lifting heavy objects, although many clinically satisfactory results have been reported. This stump pain has been suggested to result from dynamic instability of the proximal ulnar stump. Several types of tenodesis have recently been performed simultaneously with the Sauvé-Kapandji procedure to stabilize the proximal ulnar stump and thus relieve the associated pain. Although satisfactory outcomes of these stabilization procedures have been reported, correlations of the residual symptoms and radiographic findings between the conventional method and the modified method. Additionally, the mechanism of pain relief remains unclear.To elucidate the cause of proximal ulnar stump pain, the clinical results and radiographic changes were compared between 2 treatment groups in which different Sauvé-Kapandji procedures had been performed. Twenty-four wrists with distal radioulnar disorders, all of which had undergone Sauvé-Kapandji procedures, were retrospectively classified into 2 groups according to the procedure. Group A (13 wrists) was treated by the conventional surgical procedure, in which the proximal ulnar stump is not stabilized. Group B (11 wrists) was treated by the modified method, in which the proximal ulnar stump is stabilized by tenodesis with the extensor carpi ulnaris tendon. Wrist pain, proximal ulnar stump pain, ranges of forearm pronation/supination, and grip strength were investigated. The ulnar distance, ulnar gap, interosseous distance, and dorsopalmar distance were measured on both resting and dynamic radiographs.Stump pain was recognized in 6 wrists in group A and 0 in group B. However, no substantial differences in the other clinical findings or 4 radiographic parameters were found between the 2 groups.These findings suggest that stabilization of the proximal ulnar stump cannot correct either dorsal ulnar deviation or dorsal displacement of the radius. Therefore, proximal ulnar stump pain may not be caused by either radial or dorsal deviation of the proximal ulnar stump but instead by other dynamic factors.
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Ikeda M, Kawabata A, Suzuki K, Toyama M, Egi T. Outcome of the Sauvé-Kapandji procedure for distal radioulnar joint disorder with rheumatoid arthritis or osteoarthritis: Results of one-year follow-up. Mod Rheumatol 2017; 28:490-494. [PMID: 28836879 DOI: 10.1080/14397595.2017.1366005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES We performed the Sauvé-Kapandji procedure for treating disorders of the distal radioulnar joint (DRUJ) in patients with rheumatoid arthritis (RA) or osteoarthritis (OA). This study aimed to compare and clarify the results of the SK procedure between RA and OA patients. We report the one-year follow-up results of patients who underwent the SK procedure to correct the DRUJ disorder caused by RA or OA. METHODS The study included 22 wrists of 19 patients with RA and 10 wrists of nine patients with OA. Pain, grip strength and range of motion of the wrist were examined clinically. For the evaluation of the stability of the carpus, ulnar stump and bone union, parameters were measured using radiographs. Shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH) was used for functional evaluation. RESULTS Wrist pain reduced in all cases, and bone union was achieved in all wrists. The QuickDASH score significantly improved in both patients with RA and OA. In patients with RA, the range of motion increased significantly with regard to supination but decreased significantly with regard to palmar flexion. Carpal alignment and ulnar stump stability were maintained well at one-year follow-up. CONCLUSION The Sauvé-Kapandji procedure for treating disorders of the distal radioulnar joint DRUJ showed good results clinically and radiographically, irrespective of RA or OA.
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Affiliation(s)
- Mikinori Ikeda
- a Department of Orthopaedic Surgery , Higashisumiyoshi Morimoto Hospital , Osaka , Japan
| | - Akira Kawabata
- b Department of Orthopaedic Surgery , Yodogawa Christian Hospital , Osaka , Japan
| | - Keisuke Suzuki
- c Division of Hand Surgery, Department of Orthopaedic Surgery , Osaka Rosai Hospital , Osaka , Japan
| | - Masahiko Toyama
- c Division of Hand Surgery, Department of Orthopaedic Surgery , Osaka Rosai Hospital , Osaka , Japan
| | - Takeshi Egi
- d Division of Hand Surgery, Department of Orthopaedic Surgery , Osaka Saiseikai Nakatsu Hospital , Osaka , Japan
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Maeda A, Suzuki T, Hasegawa M, Kuroiwa T, Shizu K, Hayakawa K, Tsuji T, Suzuki K, Yamada H. Sauvé–Kapandji procedure with headless compression screw in patients with rheumatoid arthritis. Mod Rheumatol 2017; 28:114-118. [DOI: 10.1080/14397595.2017.1307799] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Atsushi Maeda
- Department of Orthopaedic Surgery, Fujita Health University, Aichi, Japan
| | - Taku Suzuki
- Department of Orthopaedic Surgery, Fujita Health University, Aichi, Japan
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaki Hasegawa
- Department of Orthopaedic Surgery, Fujita Health University, Aichi, Japan
| | - Takashi Kuroiwa
- Department of Orthopaedic Surgery, Fujita Health University, Aichi, Japan
| | - Kanae Shizu
- Department of Orthopaedic Surgery, Fujita Health University, Aichi, Japan
| | | | - Takashi Tsuji
- Department of Orthopaedic Surgery, Fujita Health University, Aichi, Japan
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Katsuji Suzuki
- Department of Orthopaedic Surgery, Fujita Health University, Aichi, Japan
| | - Harumoto Yamada
- Department of Orthopaedic Surgery, Fujita Health University, Aichi, Japan
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Abstract
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.
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Affiliation(s)
- Ravi K Gupta
- Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India
| | - Ashwani Soni
- Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India
| | - Anubhav Malhotra
- Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India
| | - Gladson D Masih
- Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India
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Boynton JF, Budoff JE, Clifford JW. The Effect of Forearm Bracing on Radioulnar Impingement. ACTA ACUST UNITED AC 2016; 30:157-61. [PMID: 15757768 DOI: 10.1016/j.jhsb.2004.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2004] [Accepted: 10/07/2004] [Indexed: 10/26/2022]
Abstract
The purpose of this clinical study was to compare patients’ symptoms and radioulnar convergence following distal radioulnar reconstruction with and without a functional brace on. Standardized radiographs were taken of the involved wrist at rest, while holding a weight, and during maximum power grip. All radiographs were then repeated while wearing a prefabricated functional brace (Maramed, Miami, FL). The functional brace did not decrease radioulnar convergence and, at rest, the brace actually increased radioulnar convergence. Despite this, all patients who experienced pain without the brace were pain free with the brace on. We conclude that forearm bracing may be a useful nonoperative treatment for residual pain following DRUJ salvage surgery, though its mechanism of action is unclear.
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Affiliation(s)
- J F Boynton
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX, USA
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Naito K, Sugiyama Y, Aritomi K, Nagahama Y, Tomita Y, Obayashi O, Kaneko K. Assessment of dorsal instability of the ulnar head in the distal radioulnar joint: comparison between normal wrist joints and cases of ruptured extensor tendons. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 26:161-6. [PMID: 26553200 DOI: 10.1007/s00590-015-1725-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 11/02/2015] [Indexed: 11/26/2022]
Abstract
In the present study, the adaptability of the distal radioulnar joint (DRUJ) was evaluated using conventional computed tomography (CT) evaluation methods. In addition, we investigated/compared a new method to evaluate dorsal displacement of the ulnar head. Our subjects consisted of 32 healthy volunteers (64 wrists) and 11 patients (13 wrists) with extensor tendon injuries related to dorsal displacement of the ulnar head. To diagnose instability in the DRUJ based on CT scans, the radioulnar line method and the modified radioulnar line method were measured. Instability was evaluated by the new method that the ulnar head was located on the dorsal side from a line involving the peak of Lister's tubercle in parallel to this baseline was regarded as showing abnormal dorsal displacement of the ulnar head. The diagnostic accuracy of each method was calculated. The sensitivities, specificities, false-positive rates, positive predictive values and the negative predictive value of new methods were better than other two methods. The new method that we recommend is simple. Based on the results of this study, an evaluation of normal/abnormal dorsal displacement of the ulnar head in the DRUJ using the new method may be useful for determining the timing of surgery.
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Affiliation(s)
- Kiyohito Naito
- Department of Orthopedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Yoichi Sugiyama
- Department of Orthopedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kentaro Aritomi
- Department of Orthopedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yasushi Nagahama
- Department of Orthopedic Surgery, Kyoundo Hospital, Tokyo, Japan
| | - Yoshimasa Tomita
- Department of Orthopedic Surgery, Kyoundo Hospital, Tokyo, Japan
| | - Osamu Obayashi
- Department of Orthopedic Surgery, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Kazuo Kaneko
- Department of Orthopedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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Uerpairojkit C, Leechavengvongs S, Malungpaishorpe K, Witoonchart K, Buddhavibul P. Proximal ulnar stump stability after using the pronator quadratus muscle transfer combined with the Suavé-Kapandji procedure in rheumatoid wrist. HAND SURGERY : AN INTERNATIONAL JOURNAL DEVOTED TO HAND AND UPPER LIMB SURGERY AND RELATED RESEARCH : JOURNAL OF THE ASIA-PACIFIC FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND 2014; 19:25-32. [PMID: 24641737 DOI: 10.1142/s0218810414500051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- Chairoj Uerpairojkit
- Upper Extremity and Reconstructive Microsurgery Unit, Institute of Orthopaedics, Lerdsin General Hospital, Bangkok, Thailand
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Wang W, Liu S, Liu J, Ruan H, Cai Z, Fan C. Modified Sauvé-Kapandji procedure for restoration of forearm rotation in devascularized hands. Ir J Med Sci 2014; 183:643-7. [PMID: 24470183 DOI: 10.1007/s11845-014-1067-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 01/06/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The purpose of this study is to evaluate the clinical outcomes in patients with forearm rotation limitation after successful wrist-level revascularization who underwent a modified Sauvé-Kapandji (S-K) procedure. METHODS This was a retrospective review of the clinical records of nine patients (three women, six men) after successful wrist-level revascularization who underwent late restoration of forearm rotation. All patients were evaluated using a Mayo Modified Wrist Score. The mean patient age was 35 (range 19-45) years. Mean time to reconstruction was 2.5 (range 0.5-4) years. RESULTS Mean postoperative pronation was 74°; mean postoperative supination was 80°. Overall results were excellent/good in seven patients, fair in one, and poor in one. No bone bridge was formed between the pseudarthrosis in any patient. Two patients had neurapraxia. Moderate pain and snapping occurred in one patient during movement at the ulnar amputation site. CONCLUSION This modification of the S-K procedure can restore rotation of the forearm after hand revascularization; as such, it provides an alternative salvage procedure.
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Affiliation(s)
- W Wang
- Department of Orthopaedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, No. 600 Yi Shan Road, Shanghai, 200233, People's Republic of China
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Ota N, Nakamura T, Iwamoto T, Sato K, Toyama Y. Radiographic parameter analysis on modified sauvé-kapandji procedure. J Wrist Surg 2013; 2:19-26. [PMID: 24436785 PMCID: PMC3656575 DOI: 10.1055/s-0032-1333061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
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.
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Affiliation(s)
- Norikazu Ota
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Toshiyasu Nakamura
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Takuji Iwamoto
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Kazuki Sato
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Yoshiaki Toyama
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
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Abstract
Arthrodesis is the most reliable and durable surgical procedure for the treatment of a joint disorder, and its only disadvantage is the loss of motion of the fused joint. The distal radioulnar joint can be arthrodesed, while forearm pronation and supination are maintained or even improved by creating a pseudoarthrosis of the ulna just proximal to the arthrodesis. This is known as the Sauvé-Kapandji (S-K) procedure. The Sauvé-Kapandji differs from the Darrach procedure in that it preserves ulnar support of the wrist, as the distal radioulnar ligaments and ulnocarpal ligaments are maintained. Aesthetic appearance is also superior after the S-K procedure, as the normal prominence of the ulnar head, most noticeable when the forearm is in pronation, is maintained. However, the S-K is not free of possible complications, such as nonunion or delayed union of the arthrodesis, fibrous or osseous union at the pseudoarthrosis, and painful instability at the proximal ulna stump. All of these complications can be prevented if a careful surgical technique is used.
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Affiliation(s)
- Alberto Lluch
- Institut Kaplan for Surgery of the Hand and Upper Extremity, Barcelona, Spain
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Abstract
The distal radioulnar joint (DRUJ) is the distal link between the radius and the ulna, and forms a pivot for forearm pronation and supination. As well as being susceptible to idiopathic arthritis, any injury or deformity of the DRUJ involving the radius or ulna can alter the function of this joint. Treatment options for irreparable destruction of this joint have ranged from fusion of the DRUJ joint to a variety of excision techniques with soft-tissue reconstructions, and are ever evolving. Understanding the distal ulnar anatomy is key to success.
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Affiliation(s)
- Mark Rekant
- Department of Orthopaedic Surgery, Thomas Jefferson University, PA, USA.
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Abstract
This study reports the intermediate-term results of four patients from a series eight patients who have had an insertion of a new complete distal radioulnar joint (DRUJ) prosthesis. A retrospective review was performed for all patients who underwent DRUJ joint replacement with the STABILITY Sigmoid Notch Total DRUJ System between the years of 2003 and 2008. To be included in this report, all patients had to have more than 24 months of follow-up and hand examination by the senior author. From the eight patients with this procedure, four patients met the inclusion criteria. These included one patient with painful posttraumatic arthritis, two patients with failed hemiarthroplasty, and one patient with a failed Sauvé-Kapandji procedure. Mean age at the time of surgery was 42.5 years (range: 35 to 51 years) and mean follow-up was 46 months (range: 36 to 66 months). Preoperative and postoperative assessment included range of motion, grip strength, visual analog pain scale, patient satisfaction, and radiographic evaluation. There was a successful replacement of the DRUJ in all four patients. Final range of motion showed mean pronation of 80 degrees (range: 60 to 90 degrees) and mean supination of 64 degrees (range: 45 to 90 degrees). Final grip strength on the operated extremity was 25.5 kg and averaged 73% of contralateral side. This was an improvement from preoperative grip strength of 14.5 kg visual analog pain scale decreased from 8 to 2.5 following surgery (scale: 1 to 10). Patient satisfaction was 100%. One patient returned to manual labor, one patient returned to office work, and two patients remained off work. Postoperative radiographs depict appropriate alignment of the DRUJ, and there have been no cases of subluxation or dislocation. Implant survival has been 100%. Total DRUJ joint replacement with sigmoid notch resurfacing and distal ulna replacement is an alternative to ulnar head resection in cases of DRUJ arthritis. Total DRUJ arthroplasty with this resurfacing design may provide a means of decreasing pain and restoring DRUJ stability and motion following severe trauma, failed hemiarthroplasty, or failed Sauvé-Kapandji procedure. More experience is needed with this implant to confirm these initial encouraging results. The level of evidence for this study is IV (therapeutic, case series).
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Affiliation(s)
| | - Kshamata Skeete
- Department of Orthopedics, Mayo Clinic, Rochester, Minnesota
| | - Steven L. Moran
- Department of Orthopedics, Mayo Clinic, Rochester, Minnesota
- Division of Hand Surgery, Department of Plastic Surgery, Mayo Clinic, Rochester, Minnesota
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Srikanth KN, Shahane SA, Stilwell JH. MODIFIED MATCHED ULNAR RESECTION FOR ARTHROSIS OF DISTAL RADIOULNAR JOINT IN RHEUMATOID ARTHRITIS. ACTA ACUST UNITED AC 2011; 11:15-9. [PMID: 17080523 DOI: 10.1142/s0218810406003085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2005] [Accepted: 07/10/2006] [Indexed: 11/18/2022]
Abstract
The pain of distal radioulnar arthrosis in rheumatoid patients is often due to disease largely confined to the radioulnar rather than the ulnocarpal articulation. This is a retrospective study of 14 patients (14 wrists) who underwent selective shaving of the radial articulation of the ulnar head leaving the ulnocarpal articulation intact. The ulnar head is reduced to the circumference of its shaft and a dorsal retinacular flap is interposed between it and the distal radius. Average age of the patients and follow-up were 63.5 years and 31 months, respectively. All patients had rheumatoid arthritis. Pain improved in 14 out of 15 wrists. Overall results were 67% good to excellent and 33% fair based on the modified Mayo's wrist score. This novel procedure for DRUJ arthrosis produces predictable pain relief in low demand rheumatoid patient.
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Affiliation(s)
- K N Srikanth
- Hand and Upper Limb Research Unit, Wrightington Hospital, Wrightington, Wigan and Leigh NHS Trust, Hall Lane, Appley Bridge, Wigan WN6 9EP, UK.
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Abstract
Arthrodesis is the most reliable and durable surgical procedure for the treatment of a joint disorder, with the main disadvantage of loss of motion of the fused joint. The distal radioulnar joint can be arthrodesed, while forearm pronation and supination are maintained or even improved by creating a pseudoarthrosis of the ulna just proximal to the arthrodesis. This is known as the Sauvé-Kapandji procedure. This procedure is not void of possible complications, such as nonunion or delayed union of the arthrodesis, fibrous or osseous union at the pseudoarthrosis, and painful instability at the proximal ulna stump. All of these can be prevented if a careful surgical technique is used.
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Affiliation(s)
- Alberto Lluch
- Institut Kaplan for Surgery of the Hand and Upper Extremity, Paseo Bonanova 9, 08022 Barcelona, Spain.
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32
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Giant-cell tumor of the distal ulna treated by wide resection and ulnar support reconstruction: a case report. Case Rep Med 2010; 2010:871278. [PMID: 20592994 PMCID: PMC2892703 DOI: 10.1155/2010/871278] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Accepted: 05/16/2010] [Indexed: 11/22/2022] Open
Abstract
Giant-cell tumor of bone occurred in the distal end of the ulna is extremely uncommon. A 23-year-old male had a giant-cell tumor occurred in the distal end of the ulna. After wide resection of the distal segment of the ulna including giant-cell tumor, ulnar components of the wrist joint were reconstructed with modified Sauvé-Kapandji procedure using the iliac bone graft, preserving the triangular fibrocartilage complex and ulnar collateral ligament in order to maintain ulnar support of the wrist, and the proximal stump of the resected ulna was stabilized by tenodesis using the extensor carpi ulnaris tendon. One year after operation, the patient's wrist was pain-free and had a full range of motion. Postoperative X-rays showed no abnormal findings including recurrence of the giant-cell tumor and ulnar translation of the entire carpus. The stability of the proximal stump of the distal ulna was also maintained.
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Abstract
Distal radius malunions are a common cause of patient morbidity. This review of the literature surrounding distal radius malunion covers the demographics, pathologic anatomy, and indications for surgery, surgical techniques, and salvage options. Particular emphasis is placed on subject areas that have not been reviewed as extensively in previous articles, including: intra-articular malunion, computer-assisted techniques, bone graft alternatives, and volar fixed-angle plate osteosynthesis.
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Pillukat T, van Schoonhoven J. Die Hemiresektions-Interpositionsarthroplastik des distalen Radioulnargelenks nach Bowers. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2010; 21:484-97. [DOI: 10.1007/s00064-009-1913-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Luchetti R, Khanchandani P, Da Rin F, Borelli PP, Mathoulin C, Atzei A. Arthroscopically assisted Sauvé-Kapandji procedure: an advanced technique for distal radioulnar joint arthritis. Tech Hand Up Extrem Surg 2008; 12:216-220. [PMID: 19060681 DOI: 10.1097/bth.0b013e31818ee28a] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Osteoarthritis of distal radioulnar joint (DRUJ) leads to chronic wrist pain, weakness of grip strength, and limitation of motion, all of which affect the quality of life of the patient. Over the years, several procedures have been used for the treatment of this condition; however, this condition still remains a therapeutic challenge for the hand surgeons. Many procedures such as Darrach procedure, Bower procedure, Sauvé-Kapandji procedure, and ulnar head replacement have been used. Despite many advances in wrist arthroscopy, arthroscopy has not been used for the treatment of arthritis of the DRUJ. We describe a novel technique of arthroscopically assisted Sauvé-Kapandji procedure for the arthritis of the DRUJ. The advantages of this technique are its less invasive nature, preservation of the extensor retinaculum, more anatomical position of the DRUJ, faster rehabilitation, and a better cosmesis.
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Chu PJ, Lee HM, Hung ST, Shih JT. Stabilization of the proximal ulnar stump after the Darrach or Sauvé-Kapandji procedure by using the extensor carpi ulnaris tendon. Hand (N Y) 2008; 3:346-51. [PMID: 18780014 PMCID: PMC2584221 DOI: 10.1007/s11552-008-9113-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Accepted: 04/29/2008] [Indexed: 10/22/2022]
Abstract
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.
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Affiliation(s)
- Po-Jung Chu
- Department of Orthopaedic Surgery, Taoyuan Armed Forces General Hospital, 168, Jong-Shing Rd, Taoyuan, Taoyuan County Taiwan
| | - Hung-Maan Lee
- Department of Orthopaedic Surgery, Taoyuan Armed Forces General Hospital, 168, Jong-Shing Rd, Taoyuan, Taoyuan County Taiwan
| | - Sheng-Tsai Hung
- Department of Orthopaedic Surgery, Taoyuan Armed Forces General Hospital, 168, Jong-Shing Rd, Taoyuan, Taoyuan County Taiwan
| | - Jui-Tien Shih
- Department of Orthopaedic Surgery, Taoyuan Armed Forces General Hospital, 168, Jong-Shing Rd, Taoyuan, Taoyuan County Taiwan
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38
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Nonunion of distal radius fracture and distal radioulnar joint injury: a modified Sauvé-Kapandji procedure with a cubitus proradius transposition as autograft. Arch Orthop Trauma Surg 2008; 128:1407-11. [PMID: 18677493 DOI: 10.1007/s00402-008-0708-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Indexed: 02/09/2023]
Abstract
The Sauvé-Kapandji (SK) procedure is indicated in distal radius nonunion or malunion and distal radioulnar joint (DRUJ) instability. It can also be used to treat the rheumatoid wrist with severe degenerative changes in the DRUJ. The main objective is to allow a pain-free range of movement. We present a patient with rheumatoid arthritis and distal radius nonunion who, after three operations, was treated with the SK procedure. The clinical and radiological results were excellent. A 53-year-old woman diagnosed with rheumatoid arthritis fell on her forearm at home 2 years ago. Examination at an outpatient clinic revealed a distal radius fracture classified as type V according to the Frykman classification. She had been operated three times with open reduction internal fixation using a plate, screws, and bone allograft. She came to our institution with a distal radius nonunion, positive post-traumatic ulnar variance, and ulnar nerve paresis. The range of movements was 20 degrees -10 degrees flexion-extension and 40 degrees -30 degrees pronation-supination, and she needed daily fentanyl. We performed a modified SK procedure with an autologous iliac crest bone graft and ulnar bone graft from the osteotomy area (cubitus proradius), bone morphogenetic protein, and a low profile distal radius plate. After 1 year of follow-up, the distal radius fracture has healed and the wrist is pain-free with a complete range of movement in flexion-extension and pronation-supination. The main indication for the SK procedure is post-traumatic positive ulnar variance and associated ulnocarpal impaction. The cubitus proradius bone graft transposition is an interesting technical note that makes this case a challenge for skilled orthopedic hand surgeons.
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39
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Slagel BE, Luenam S, Pichora DR. Management of post-traumatic malunion of fractures of the distal radius. Orthop Clin North Am 2007; 38:203-16, vi. [PMID: 17560403 DOI: 10.1016/j.ocl.2007.03.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Distal radius malunions are a common cause of patient morbidity. This review of the literature surrounding distal radius malunion covers the demographics, pathologic anatomy, and indications for surgery, surgical techniques, and salvage options. Particular emphasis is placed on subject areas that have not been reviewed as extensively in previous articles, including: intra-articular malunion, computer-assisted techniques, bone graft alternatives, and volar fixed-angle plate osteosynthesis.
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Affiliation(s)
- Bradley E Slagel
- Division of Orthopaedic Surgery, Kingston General Hospital, Room 9-311, 76 Stuart Street, Queen's University, Kingston, Ontario, K7L 2V7, Canada
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40
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Minami A, Iwasaki N, Ishikawa JI, Suenaga N, Yasuda K, Kato H. Treatments of osteoarthritis of the distal radioulnar joint: long-term results of three procedures. ACTA ACUST UNITED AC 2006; 10:243-8. [PMID: 16568521 DOI: 10.1142/s0218810405002942] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2005] [Accepted: 12/16/2005] [Indexed: 11/18/2022]
Abstract
Sixty-one wrists in 61 patients with osteoarthritis of the distal radioulnar joint treated by three consecutive procedures (20 Darrach, 25 Sauvé-Kapandji and 16 hemiresection-interposition arthroplastic procedures) were retrospectively evaluated. We preferred to perform Darrach's procedure in even the early stages of osteoarthritis of the distal radioulnar joint prior to introduction of Sauvé-Kapandji and hemirestion-interposition arthroplastic procedures. Subsequently the hemirestion-interposition arthroplasty was indicated when the triangular fibrocartilage cartilage was intact or could be reconstructed and the Sauvé-Kapandji when the triangular fibrocartilage complex could not be reconstructed or there was positive ulnar variance of more than 5 mm even though the triangular fibrocartilage complex was functional. Patient's age at operation averaged 59.8 years. There were 36 men and 25 women. There were 38 primary and 23 secondary osteoarthritis cases. Post-operative pain, range of motion, grip strength, return to work status; and radiographic results were evaluated. At the five- to 14-year (average, ten years) follow-up evaluation, relief of pain from Darrach procedure was inferior to the Sauvé-Kapandji procedure and hemiresection-interposition arthroplasty although this was not statistically significant. After both the Sauvé-Kapandji procedure and hemiresection-inteposition arthroplasty, post-operative improvements in flexion and extension of the wrist had statistical significance. Post-operative improvements in pronation and supination of the forearm showed statistical significances after all procedures. Improvements of post-operative grip strength and return to an original job in the Sauvé-Kapandji procedure and hemiresection-interposition arthroplasty were statistically superior to those with a Darrach's procedure. There were many post-operative complications following the Darrach's procedure. Darrach's procedure is better indicated for severe osteoarthritic changes of the distal radioulnar joint in elderly patients. We believe the operative indications between the Sauvé-Kapandji procedure and hemiresection-interposition arthroplasty are best determined prior to surgery by the existence and status of the triangular fibrocartilage complex and the amount of the positive ulnar variance.
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Affiliation(s)
- Akio Minami
- Department of Orthopaedic Surgery, Hokkaido University School of Medicine, Sapporo, Japan.
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41
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42
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Daecke W, Martini AK, Schneider S, Streich NA. Amount of ulnar resection is a predictive factor for ulnar instability problems after the Sauvé-Kapandji procedure: a retrospective study of 44 patients followed for 1-13 years. Acta Orthop 2006; 77:290-7. [PMID: 16752293 DOI: 10.1080/17453670610046055] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The Sauvé-Kapandji procedure can result in instability of the proximal ulnar stump. PATIENTS AND METHODS We reviewed 44 patients (mean follow-up time 6 (0.6-13) years) to investigate predictive factors for ulnar instability after Sauvé-Kapandji operation. We used several scores including an instability score specifically designed for this study. RESULTS Patients with a longer proximal ulnar stump had significantly lower instability scores, significantly better Mayo Modified wrist scores and DASH scores, and also less pain than those with shorter proximal ulna. INTERPRETATION If the shortening of the proximal stump is less than 35 mm, a reliable improvement in motion and a high patient satisfaction can be expected. The risk of a painful ulnar instability is related to the amount of resection, and can be reduced by creating a long upper ulnar stump.
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Affiliation(s)
- Wolfgang Daecke
- Department of Hand and Microsurgery, University of Heidelberg, Germany
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43
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Fernandez DL, Joneschild ES, Abella DM. Treatment of failed Sauvé-Kapandji procedures with a spherical ulnar head prosthesis. Clin Orthop Relat Res 2006; 445:100-7. [PMID: 16601411 DOI: 10.1097/01.blo.0000205901.13609.70] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
UNLABELLED Radioulnar convergence is a painful complication after a Sauvé-Kapandji procedure, with a reported incidence of 13% to 39%. We evaluated 10 patients with painful radioulnar convergence treated with a spherical ulnar head prosthesis proximal to the radioulnar fusion mass. At a mean follow-up of 2.6 years, patients were evaluated clinically and radiographically to determine whether an ulnar head replacement could restore forearm stability, prevent radioulnar convergence, and reduce pain. Postoperatively, no patient had subjective complaints of radioulnar convergence or clinical signs of distal ulnar instability. Pain had improved in all patients. Grip strength, expressed as a percentage of the uninjured hand, improved on average from 27% to 55%. Range of motion improved in seven patients, worsened in two and remained the same in one. Nine of 10 patients returned to their previous occupation with an average working capacity of 76%. The prosthesis was stable radiographically in all patients. Complications included two fractures of the radioulnar fusion mass and the development of painful periprosthetic calcifications in one patient. Placement of a spherical ulnar head prosthesis after a Sauvé-Kapandji procedure provides adequate early results for patients with painful radioulnar convergence. LEVEL OF EVIDENCE Therapeutic study, level IV (case series).
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Affiliation(s)
- Diego L Fernandez
- Department of Orthopaedic Surgery, Lindenhof Hospital, Bern, Switzerland.
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44
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Affiliation(s)
- Robert M Szabo
- Department of Orthopaedic Surgery, University of California, Davis, School of Medicine, Sacramento 95817, USA.
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45
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Minami A, Iwasaki N, Ishikawa JI, Suenaga N, Kato H. Stabilization of the proximal ulnar stump in the Sauvé-Kapandji procedure by using the extensor carpi ulnaris tendon: long-term follow-up studies. J Hand Surg Am 2006; 31:440-4. [PMID: 16516739 DOI: 10.1016/j.jhsa.2005.11.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2005] [Revised: 11/01/2005] [Accepted: 11/01/2005] [Indexed: 02/02/2023]
Abstract
PURPOSE 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. METHODS 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. RESULTS The results of this series after 95 months of follow-up evaluation were similar to the results at 35 months. CONCLUSIONS 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. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic, Level IV.
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Affiliation(s)
- Akio Minami
- Department of Orthopaedic Surgery, Hokkaido University School of Medicine, Nishi-7-chome, Sapporo, Japan.
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46
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Lim BH, Loh SY. Reconstruction of a Posttrauma Arthritic Distal Radioulnar Joint by Vascularized Second Metatarsophalangeal Joint Transfer. Plast Reconstr Surg 2006; 117:19e-23e. [PMID: 16462309 DOI: 10.1097/01.prs.0000197137.40001.dc] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Beng-Hai Lim
- Department of Orthopedics, Hand and Reconstructive Microsurgery, National University Hospital, Singapore.
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47
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Daecke W, Martini AK, Schneider S, Streich NA. Klinische Ergebnisse nach Sauv�-Kapandji-Operation in Abh�ngigkeit der Erkrankung. Unfallchirurg 2004; 107:1057-64. [PMID: 15300329 DOI: 10.1007/s00113-004-0823-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We present the results of a retrospective study on 56 patients who underwent the Sauve-Kapandji procedure for chronic disorders of the distal radioulnar joint (DRUJ). Outcome was assessed with special regard to the diagnosis. The average follow-up was 5.9 years (1-12 years). Patients were assessed for pain, range of motion of wrist and forearm, and radiological features. The DASH score and Mayo wrist score were used. The diagnosis had an influence on the outcome. Patients with primary arthrosis of the DRUJ demonstrated better results than patients with traumatic disorders. Patients with growth deficiency-related complaint of the DRUJ showed slightly inferior results after the Sauve-Kapandji procedure compared to all patients. Patients were free of pain or had pain only during heavy labor in 81% of cases; 95% of the patients rated the outcome as excellent or improved, but only 50% were free of symptoms on the operated side during heavy manual labor. Symptoms of ulnar impingement were found in 11%. Improvement in range of motion of wrist and forearm was significant. The postoperative DASH score was 24.2+/-22.5 and the Mayo wrist score was 76.1+/-17.6. Our results confirm the Sauve-Kapandji procedure to be a reliable salvage procedure resulting in high patient satisfaction and reliable improvement in range of motion. However, decreased grip strength on the affected side must be accepted to some extent. The diagnosis of a DRUJ disorder influences the outcome.
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Affiliation(s)
- W Daecke
- Sektion für Hand- und Mikrochirurgie, Abteilung Orthopädie I, Stiftung Orthopädische Universitätsklinik, Heidelberg.
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48
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Daecke W, Streich NA, Martini AK. [The Sauvé-Kapandji operation. Indications and results]. DER ORTHOPADE 2004; 33:698-703. [PMID: 15127198 DOI: 10.1007/s00132-004-0657-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The Sauvé-Kapandji procedure consists of an arthrodesis of the distal radioulnar joint (DRUJ) in combination with an intentional pseudarthrosis of the distal ulna. In addition to other methods, the Sauvé-Kapandji operation is a salvage procedure of for chronic disorders of DRUJ. Different studies have confirmed that this procedure results in a pain reduction of between 73 and 100% and that patient' satisfaction lies between 68 and 100%. A reliable improvement of rotation of the forearm of between 134 and 171 degrees can be expected. On the other hand, a decrease in grip strength on the affected side is usual. The potential problem of instability of the proximal ulna stump can be avoided by performing a short distal segment and a narrow pseudarthrosis gap. The Sauvé-Kapandji procedure is a reliable salvage procedure resulting in high patient satisfaction and a reliable improvement in range of motion.
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Affiliation(s)
- W Daecke
- Sektion für Hand- und Mikrochirurgie-Abteilung Orthopädie I, Stiftung Orthopädische Universitätsklinik Heidelberg.
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49
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Van Schoonhoven J, Lanz U. [Salvage operations and their differential indication for the distal radioulnar joint]. DER ORTHOPADE 2004; 33:704-14. [PMID: 15269875 DOI: 10.1007/s00132-004-0660-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The most common cause of an arthritically damaged distal radioulnar joint is a malunion of a distal radius fracture. Therapeutically, ulnar head resection, hemiresection-interposition-technique, Kapandji-Sauvé procedure and implantation of an ulnar head prosthesis have been described. None of these procedures is able to restore the complete function of the joint. Therefore, anatomical reconstruction of the joint in acute or secondary correction osteotomy for malunited fractures of the distal radius should be performed to avoid the development of the arthrosis. Numerous clinical studies have demonstrated a similar reduction of the clinical symptoms for all procedures. Therefore, classification of the different procedures has to consider the number of complications. Biomechanically, partial resection of the distal ulna will destabilize the distal radioulnar context and clinically may lead to painful radioulnar and/or dorsopalmar instability of the distal ulnar stump. Biomechanically and clinically, this complication, next to secondary extensor tendon ruptures, has to be expected far more often following complete resection of the ulnar head than in the alternative procedures. We do not see any remaining indication for complete resection of the ulnar head. Clinical results and the occurrence of painful instability of the distal ulnar stump have been reported almost identically for the hemiresection-interposition technique and the Kapandji Sauvé procedure. Therefore, both procedures appear to be equally suitable for the treatment of painful arthrosis of the distal radioulnar joint. In patients with a preexisting instability of the distal radioulnar joint, or a major deformity of the radius or the ulna, we prefer to perform the hemiresection-interposition-technique. In these conditions we consider the remaining contact of the triangular fibrocartilage complex with the distal end of the ulna a biomechanical advantage to reduce the risk of secondary instability. Biomechanically as well as clinically, replacement of the ulnar head using a prosthesis has been shown to either avoid or solve the problem of instability. We therefore consider ulnar head replacement the treatment of choice in secondary painful instability following resection procedures at the distal end of the ulna. Primary ulnar head replacement should be considered in special indications until long-term follow-up results are available.
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Affiliation(s)
- J Van Schoonhoven
- Klinik für Hand- und Fusschirurgie, St.-Franziskus-Hospital, Münster.
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Brunet P, Moineau G, Liot M, Burgaud A, Dubrana F, Le Nen D. Étude radioclinique de l'instabilité du moignon proximal de l'ulna après l'intervention de Sauvé-Kapandji pour séquelles post-traumatiques. ACTA ACUST UNITED AC 2004; 23:178-83. [PMID: 15484677 DOI: 10.1016/j.main.2004.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The aim of the study was to analyse the ulnar proximal stump's behaviour after Sauvé-Kapandji procedure. The procedure was performed for post-traumatic disorders of the distal radio-ulnar joint. This is a retrospective study of 14 patients. The mean age of patients at the operation was 49 years. Most of them began immediate mobilisation into pronation and supination. After a 5 year follow-up period, the clinical examination was centred on the ulnar proximal stump. An original radiologic study was made with static and dynamic X-Ray. Seven patients indicated pain on the ulnar stump during pronosupination. A clunk on the ulnar side of the wrist was noticed by three patients and an instability of the ulnar stump was observed two times. Clinically, there were a sagittal instability in all patients and a frontal instability four times. The sagittal instability was confirmed by dynamic X-Ray on each occasion, but the frontal instability was never confirmed. Every patient had instability of the ulnar stump; however, it was well tolerated. In practice, 12 patients were satisfied or very satisfied (86%). Instability of the proximal ulnar stump remains a problem, because it occurs despite a strict technique.
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Affiliation(s)
- P Brunet
- Service d'orthopédie, traumatologie et urgences main, hôpital de la Cavale-Blanche, CHU de Brest, boulevard Tanguy-Prigent, 29609 Brest , France.
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