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.
Key words
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References
- Nouvelle technique de traitement chirurgical des luxations récidivantes isolées de l'extrémité inférieure du cubitus [in French].J Chir (Paris). 1936; 47: 589-594
- Modified Sauve-Kapandji procedure for patients with old fractures of the distal radius.Open Med. 2017; 12: 417-423
- Modified Sauvé-Kapandji procedure for the distal radioulnar joint disorders of osteoarthritis and rheumatoid arthritis.J Orthop Sci. 2018; 23: 516-520
- The Sauvé-Kapandji procedure for posttraumatic disorders of the distal radioulnar joint.Acta Orthop Belg. 2004; 70: 226-230
- The Sauve-Kapandji procedure for post-traumatic disorders of the distal radio-ulnar joint.J Bone Joint Surg Br. 2000; 82: 1013-1018
- Results of the modified Sauvé-Kapandji procedure in the treatment of chronic posttraumatic derangement of the distal radioulnar joint.J Bone Joint Surg Am. 1998; 80: 1758-1769
- The Sauvé-Kapandji procedure for nonrheumatic disorders of the distal radioulnar joint.Acta Orthop Belg. 1994; 60: 225-230
- Upper Extremity Collaborative Group. Development of the QuickDASH.J Bone Joint Surg. 2005; 87: 1038-1046
- Psychometric properties of the shortened disability of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) and Numeric Pain Rating Scale in patients with shoulder pain.J Shoulder Elbow Surg. 2009; 18: 920-926
- Minimal clinically important differences of 3 patient-rated outcomes instruments.J Hand Surg Am. 2013; 38: 641-649
- Klinische Langzeitergebnisse der Kapandji-Sauvé-Operation.Handchir Mikrochir Plast Chir. 2003; 35: 157-163
- Initial shortening and internal fixation in combination with a Sauvé-Kapandji procedure for severely comminuted fractures of the distal radius in elderly patients.J Bone Joint Surg Br. 2010; 92: 1558-1562
- The Sauve-Kapandji procedure and the Darrach procedure for distal radio-ulnar joint dysfunction after Colles’ fracture.J Hand Surg Br. 2004; 29: 608-613
- Outcome of the Sauvé–Kapandji procedure for distal radioulnar joint disorder with rheumatoid arthritis or osteoarthritis: results of one-year follow-up.Mod Rheumatol. 2018; 28: 490-494
- Kinematics of the wrist: II. Clinical applications.J Bone Joint Surg Am. 1978; 60: 955-961
- Radiolunate arthrodesis: factor of stability for the rheumatoid wrist.Ann Chir Main. 1983; 2: 5-17
- Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg. 2004; 240: 205-213
- Proximal ulnar stump stability after using the pronator quadratus muscle transfer combined with the Suave-Kapandji procedure in rheumatoid wrist.Hand Surg. 2014; 19: 25-32
- Modified Sauvé-Kapandji procedure for rheumatoid wrists: a long-term study with a minimum follow-up of 5 years.Mod Rheumatol. 2014; 24: 426-429
- Comparison of the Sauvé–Kapandji procedure and the Darrach procedure for the treatment of rheumatoid wrists.Mod Rheumatol. 2003; 13: 239-242
- Radiographic parameter analysis on modified Sauvé-Kapandji procedure.J Wrist Surg. 2013; 2: 19-26
- Long-term results of the Sauvé-Kapandji procedure in the rheumatoid wrist.Acta Orthop Belg. 2013; 79: 655-659
- The Sauve-Kapandji procedure for reconstruction of the rheumatoid distal radioulnar joint.J Hand Surg Am. 1993; 18: 978-983
- The Sauvé-Kapandji procedure for osteoarthritis of the distal radioulnar joint.J Hand Surg Am. 1995; 20: 602-608
- 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.Int Orthop. 2018; 42: 2173-2179
Article info
Publication history
Published online: January 13, 2020
Accepted:
November 22,
2019
Received:
March 22,
2019
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2020 by the American Society for Surgery of the Hand. All rights reserved.
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