Functional Outcomes After Sauve-Kapandji Arthrodesis (2023)

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The Journal of Hand Surgery

Volume 45, Issue 5,

May 2020

, Pages 408-416

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.

(Video) Controversial Topics in Hand Surgery Hand Fellowship Debates Series DRUJ Arthritis

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.

Section snippets

Materials and Methods

Institutional review board approval was obtained for a retrospective review of patients who underwent SK in 2 health care systems over 10 years (2008–2018). Patients were identified using Current Procedural Terminology code 25830, and a review of the medical record was performed recording demographic information, preoperative characteristics, intraoperative and perioperative data, and postoperative outcomes. In our practices, SK arthrodesis is preferred over Darrach resection or hemiresection

Patient demographics

The study included 57 patients (21 men and 36 women), average age 51.8 ± 14.9 years (range, 23–76 years). The most common SK indications were posttraumatic arthritis (n= 35), RA (n= 10), and primary osteoarthritis (n= 7) (Table2). Median interval from symptom presentation to surgery was 20.4 months (range, 1.7–369.2 months) and median follow-up interval was 24.5 months (range, 12–108 months).

Quick–Disabilities of the Arm, Shoulder, and Hand scores

Mean preoperative QuickDASH score was 52 (range, 16–97). The mean QuickDASH score increased after 6

Discussion

This study demonstrates that SK significantly improves functional outcomes for patients with DRUJ pathology at 12 months after surgery. The QuickDASH scores improved beyond the preoperative baseline by 3 months after surgery, with clinically and statistically significant improvements at 12 months.

Based on these data, SK provides functional benefits for patients with osteoarthritis and for those with inflammatory arthritis. Both groups demonstrated clinically and statistically significant

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    © 2020 by the American Society for Surgery of the Hand. All rights reserved.

    FAQs

    What is Sauve Kapandji? ›

    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.

    What is Kapandji procedure? ›

    In 1936, Sauvé and Kapandji described a procedure that included an arthrodesis across the distal radioulnar joint and created a pseudarthrosis of the ulna, proximal to the fusion, to restore pronation and supination.

    What is DRUJ in orthopedics? ›

    The distal radioulnar joint (DRUJ) is part of the complex forearm articulation that includes proximal radioulnar joint (PRUJ), forearm bones, and interosseous membrane (IOM) allowing pronosupination. It is functionally and anatomically integrated with the ulnocarpal articulation of wrist.

    What is Madelung's deformity? ›

    Madelung's deformity is a rare arm condition that affects the growth plate of the radius, a bone in the forearm. As a child grows, this abnormal growth results in a misalignment where the two long bones of the forearm (the radius and ulna) meet the bones of the wrist.

    What does arthrodesis mean? ›

    Arthrodesis is the fusion of vertebrae over a joint space that occurs through a natural process or as a result of surgical procedure.

    What is ulnar variance? ›

    Ulnar variance, also known as Hulten variance, refers to the difference in height between the joint surfaces of the distal radius and ulna.

    What is caput Ulnae syndrome? ›

    the name “caput ulnae syndrome”. The main clinical characteristics. are: (1 ) rotational pain, weakness and limitation of movement in the. wrist, (2) the caput ulnae is dislocated and forms a dorsal prominence. on the wrist, (3) in a dorso-ulnar position there is a tender soft fluc-

    What is DRUJ arthroplasty? ›

    DRUJ prostheses have been developed to replace the mechanical function of the ulnar head in patients with pain related to distal ulnar resection (1, 3) and post-traumatic arthritis (2).

    What position is DRUJ most stable? ›

    Generally speaking, a dorsal dislocation is most stable in supination while a volar dislocation is more stable in pronation. If the DRUJ is unstable after reduction, the radioulnar joint may be pinned in the position of greatest stability.

    How do you fix DRUJ instability? ›

    Surgery should be considered for DRUJ instability to recover bone and ligament injuries if nonsurgical treatment fails to restore forearm stability and function. To recover bone deformities, osteotomies of the radius,14,15 ulna,16 or, in some cases, sigmoid notch osteoplasty17 are used.

    How do I check my DRUJ instability? ›

    DRUJ stress test or ballottement test: The radiocarpal joint is stabilized with one hand while the ulna is shucked with another hand against the radius. The test is positive if it is aching and severely unstable in symptomatic individuals. The test has a specificity of 96% but solely a sensitivity of 59% (31).

    Can Madelung deformity be fixed? ›

    The treatment for Madelung's deformity is surgical. Several techniques have been described. Conservative surgical treatment aims to correct the position of the distal radial articular surface and to restore satisfactory radial and ulnar anatomy.

    Is madelung disease fatal? ›

    Madelung's disease (MD), also known as multiple symmetric lipomatosis, Launois-Bensaude syndrome and benign symmetric lipomatosis, is a rare disorder of adipose metabolism [1]. MD lesions do not affect survival, but comorbidities can be life-threatening [2].

    What is a dinner fork deformity? ›

    A dinner fork deformity, also known as a bayonet deformity, occurs as the result of a malunited distal radial fracture, usually a Colles fracture. The distal fragment is dorsally angulated, displaced and often also impacted.

    Is arthrodesis a major surgery? ›

    Arthrodesis in the wrist stabilizes the joint. It fuses the long bone in your forearm to the smaller bones in your wrist. This is a major surgical procedure. Your doctor may only recommend it after trying conservative treatments first.

    Is arthrodesis the same as a fusion? ›

    Arthrodesis, also referred to as a joint fusion, the uniting of two bones at a joint, is typically completed through surgery. In simple terms, the orthopedic surgeon manually straightens out the damaged joint, removes the cartilage, and then stabilizes the bone so that they heal together.

    What is another word for arthrodesis? ›

    Arthrodesis, also known as artificial ankylosis or syndesis, is the artificial induction of joint ossification between two bones by surgery.

    Is ulnar impaction syndrome a disability? ›

    Can I Get Disability for My Ulnar Nerve Condition? To be eligible for disability because of your ulnar nerve condition, the Social Security Administration (SSA) must conclude that it is so severe that it prevents you from working at the substantial gainful activity (SGA) level for at least twelve months.

    Does ulnar variance cause pain? ›

    Ulnar impaction syndrome is caused by the impaction between the ulnar carpal bone and the ulnar head, a phenomenon that can also lead to ulnar-sided wrist pain and that tends to occur when there is positive ulnar variance and a degenerative/osteoarthritic condition of the ulnar side of the wrist related to excessive ...

    Is positive ulnar variance bad? ›

    3 A positive ulnar variance is harmful to the ulnar compartment of the wrist as it causes degradation and perforation of the triangular fibrocartilage complex and carpal bones cartilaginous wear (ulnar impaction syndrome).

    What does rheumatoid arthritis feel like in your feet? ›

    RA and symptoms in the feet

    persistent aching or soreness in the feet, especially after walking, running, or standing for long periods of time. abnormal warmth in one or more areas of the foot, even if the rest of the body is relatively cool. swelling, especially in one or more toe joints or in your ankles.

    What causes ulnar impaction syndrome? ›

    Ulnar impaction syndrome is a progressive degenerative condition, most commonly resulting from repetitive abutment of a lengthened ulna, with the TFCC, lunate, triquetrum, and lunotriquetral ligament.

    What causes ulnar deviation in rheumatoid arthritis? ›

    Ulnar deviation can occur due to chronic inflammation from rheumatoid arthritis (RA). RA is a chronic inflammatory disease in which the body's immune system attacks the soft tissue or synovium that lines the surface of joints.

    What is Barton fracture? ›

    A Barton fracture is a compression injury with a marginal shearing fracture of the distal radius. The most common cause of this injury is a fall on an outstretched, pronated wrist.

    What is radial inclination? ›

    Radial inclination is the angle between one line drawn perpendicular to the long axis of the radius and a second line from the tip of the radial styloid to the central reference point (CRP).

    Why is it called chauffeur fracture? ›

    Why is it called a “chauffeur fracture”? French orthopaedic surgeon Just Lucas-Championnière named this fracture after the many chauffeurs who started cars in the early 20th century. At the time, people started cars by vigorously turning a crank-handle clockwise.

    What is Bennett fracture? ›

    Bennett fracture is the most common fracture involving the base of the thumb. This fracture refers to an intraarticular fracture that separates the palmar ulnar aspect of the first metacarpal base from the remaining first metacarpal.

    How long does it take for Barton fracture to heal? ›

    How long does it take to heal from a Barton fracture? If you don't get surgery, you'll have to wear a cast around your wrist for about six weeks and then go to physical therapy. At therapy, you'll work on your wrist movement and strength. You may feel better in a few months, but healing can take a year.

    What is loss of radial inclination? ›

    Loss of radial inclination causes radial deviation of the wrist, whereas radial shortening leads to incongruity of the DRUJ and positive ulnar variance. Excessive dorsal tilt results in carpal malalignment, leading to carpal instability and arthritis.

    What does volar tilt mean? ›

    The volar tilt, or palmar/volar inclination, is an angle between a line drawn perpendicular to the long axis of the radius and a tangential line drawn along the radial articular surface.

    What is Lafontaine criteria? ›

    Accordingly, Lafontaine considered a distal radius fracture unstable if three or more of the following factors were present: dorsal angulation exceeding 20°; dorsal comminution; intra-articular radiocarpal fracture; associated ulnar fracture; and age over 60 years.

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