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
