Radiographic Parameter Analysis on Modified Sauvé-Kapandji Procedure

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.

Keywords

modified Sauvé-Kapandji - radiographic evaluation - distal radioulnar joint

• References

• 1 Backdähl M. The caput ulnae syndrome in rheumatoid arthritis. A study of the morphology, abnormal anatomv and clinical picture. Acta Rheumatol Scand Suppl 1963; 5: 1-75
• 2 Vesely DG. The distal radio-ulnar joint. Clin Orthop Relat Res 1967; 51: 75-91
• 3 Darrach W. Anterior dislocation of the head of the ulna. Ann Surg 1912; 56: 802-803
• 4 Rana NA, Taylor AR. Excision of the distal end of the ulna in rheumatoid arthritis. J Bone Joint Surg Br 1973; 55 (1) 96-105
• 5 Newman RJ. Excision of the distal ulna in patients with rheumatoid arthritis. J Bone Joint Surg Br 1987; 69 (2) 203-206
• 6 Van Gemert AML, Spauwen PHM. Radiological evaluation of the long-term effects of resection of the distal ulna in rheumatoid arthritis. J Hand Surg [Br] 1994; 19 (3) 330-333
• 7 Sauvé L, Kapandji M. Nouvelle technique de traitement chirurgical des luxations recidivantes isolees de l'extremite inferieure du cubitus. J Chir (Paris) 1936; 47: 589-594
• 8 Gonçalves D. Correction of disorders of the distal radio-ulnar joint by artificial pseudarthrosis of the ulna. J Bone Joint Surg Br 1974; 56B (3) 462-464
• 9 Kapandji IA. The Kapandji-Sauvé operation. Its techniques and indications in non rheumatoid diseases. Ann Chir Main 1986; 5 (3) 181-193
• 10 Nakamura R, Tsunoda K, Watanabe K, Horii E, Miura T. The Sauvé-Kapandji procedure for chronic dislocation of the distal radio-ulnar joint with destruction of the articular surface. J Hand Surg [Br] 1992; 17 (2) 127-132
• 11 Minami A, Suzuki K, Suenaga N, Ishikawa J. The Sauvé-Kapandji procedure for osteoarthritis of the distal radioulnar joint. J Hand Surg Am 1995; 20 (4) 602-608
• 12 Arnett FC, Edworthy SM, Bloch DA , et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988; 31 (3) 315-324
• 13 Larsen A. Radiological grading of rheumatoid arthritis. An interobserver study. Scand J Rheumatol 1973; 2 (3) 136-138
• 14 DiBenedetto MR, Lubbers LM, Coleman CR. A standardized measurement of ulnar carpal translocation. J Hand Surg Am 1990; 15 (6) 1009-1010
• 15 Bell MJ, Hill RJ, McMurtry RY. Ulnar impingement syndrome. J Bone Joint Surg Br 1985; 67 (1) 126-129
• 16 Bieber EJ, Linscheid RL, Dobyns JH, Beckenbaugh RD. Failed distal ulna resections. J Hand Surg Am 1988; 13 (2) 193-200
• 17 Lichtman DM, Ganocy TK, Kim DC. The indications for and techniques and outcomes of ablative procedures of the distal ulna. The Darrach resection, hemiresection, matched resection, and Sauvé-Kapandji procedure. Hand Clin 1998; 14 (2) 265-277
• 18 Fraser KE, Diao E, Peimer CA, Sherwin FS. Comparative results of resection of the distal ulna in rheumatoid arthritis and post-traumatic conditions. J Hand Surg [Br] 1999; 24 (6) 667-670
• 19 Lee SK, Hausman MR. Management of the distal radioulnar joint in rheumatoid arthritis. Hand Clin 2005; 21 (4) 577-589
• 20 Rizzo M, Cooney III WP. Current concepts and treatment for the rheumatoid wrist. Hand Clin 2011; 27 (1) 57-72
• 21 Minami A, Iwasaki N, Ishikawa J, Suenaga N, Yasuda K, Kato H. Treatments of osteoarthritis of the distal radioulnar joint: long-term results of three procedures. Hand Surg 2005; 10 (2-3) 243-248
• 22 Shaaban H, Giakas G, Bolton M, Williams R, Scheker LR, Lees VC. The distal radioulnar joint as a load-bearing mechanism—a biomechanical study. J Hand Surg Am 2004; 29 (1) 85-95
• 23 Nakamura T, Yabe Y, Horiuchi Y. Functional anatomy of the triangular fibrocartilage complex. J Hand Surg [Br] 1996; 21 (5) 581-586
• 24 Spinner M, Kaplan EB. Extensor carpi ulnaris. Its relationship to the stability of the distal radio-ulnar joint. Clin Orthop Relat Res 1970; 68: 124-129
• 25 Tang JB, Ryu J, Kish V. The triangular fibrocartilage complex: an important component of the pulley for the ulnar wrist extensor. J Hand Surg Am 1998; 23 (6) 986-991
• 26 Nakagawa N, Abe S, Kimura H, Imura S, Nishibayashi Y, Yoshiya S. Comparison of the Sauvé-Kapandji procedure and the Darrach procedure for the treatment of rheumatoid wrists. Mod Rheumatol 2003; 13: 239-242
• 27 Slater RR. The Sauve-Kapandji procedure. J Hand Surg Am 2008; 33: 1632-1638
• 28 Fujita S, Masada K, Takeuchi E, Yasuda M, Komatsubara Y, Hashimoto H. Modified Sauve-Kapandji procedure for disorders of the distal radioulnar joint in patients with rheumatoid arthritis. Surgical technique. J Bone Joint Surg Am 2006; 88 (Suppl 1 Pt 1): 24-28