Sauve-Kapandji Remains a Viable Option for Distal Radioulnar Joint Dysfunction
Nicholas Munaretto, MD; William Aibinder, MD; Steven L Moran, MD; Marco Rizzo, MD
Mayo Clinic, Rochester, MN
Introduction. Dysfunction of the distal radioulnar joint (DRUJ) can be significantly debilitating. Various surgical treatment options exist with no clear superiority of any procedure reported in the literature. The Sauve-Kapandji (S-K) procedure which involves an ulnar resection with arthrodesis of the DRUJ provides several advantages including maintenance of ulnar support of the carpus, the ability to shorten the ulna if needed, and a relatively short period of immobilization. The aim of this study was to review our institution's results performing the S-K procedure for DRUJ dysfunction associated with rheumatoid arthritis, post-traumatic arthrosis, osteoarthritis, and congenital malformations.
Materials and Methods.A retrospective review of 35 Sauve-Kapandji procedures performed at our institution between 1998 and 2017 with a minimum of 1 year follow-up was performed. The mean age was 51 years (range, 17 to 78). The indication for surgery was inflammatory arthritis in 22, post-traumatic osteoarthrosis in 5, osteoarthritis in 4, and congenital malformation in 4. The cohort included 30 females and 5 males. Pre-operative and post-operative range of motion and pain scores were reviewed. Radiographs were reviewed for ulnar resection gap, DRUJ healing, and carpal translation. The mean follow-up was 49.5 months (range, 12 to 217).
Results. The mean pain scores improved significantly in our cohort (p < 0.001). The mean post-operative grip strength improved from 9 kg to 13 kg (p = 0.004). The post-operative range of motion improved in regards to pronation, supination, and wrist extension (p = 0.72, 0.69, and 0.74, respectively). There was a slight decrease in wrist flexion from 43? to 34 ? (p = 0.01). Successful union was noted in 100% of the wrists. There were 12 reoperations, including 8 prominent screw removals, 1 heterotopic ossification excision, 1 distal ulna stabilization, and 2 resection interposition arthroplasties utilizing an Achilles tendon allograft.
Conclusion. The S-K procedure has several theoretical benefits compared to other procedures for DRUJ dysfunction. The results of this study demonstrate excellent pain relief with reasonable post-operative range of motion and a high rate of successful arthrodesis. Complication rates were low with a majority of reoperations for prominent hardware. Thus, the S-K procedures is a viable option for DRUJ dysfunction.
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