Functional Outcomes After Sauve-Kapandji Arthrodesis (2023)


Corporate sign inSign in / register


  • Access throughyour institution

The Journal of Hand Surgery

Volume 45, Issue 5,

May 2020

, Pages 408-416


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.


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


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.


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


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

References (25)

  • A. Minami et al.The Sauvé-Kapandji procedure for osteoarthritis of the distal radioulnar joint

    JHand Surg Am


  • K.A. Vincent et al.The Sauve-Kapandji procedure for reconstruction of the rheumatoid distal radioulnar joint

    JHand Surg Am


  • A. Chamay et al.Radiolunate arthrodesis: factor of stability for the rheumatoid wrist

    Ann Chir Main


  • M.S. George et al.The Sauve-Kapandji procedure and the Darrach procedure for distal radio-ulnar joint dysfunction after Colles’ fracture

    JHand Surg Br


  • A.A. Sorensen et al.Minimal clinically important differences of 3 patient-rated outcomes instruments

    JHand Surg Am


  • P.E. Mintken et al.Psychometric properties of the shortened disability of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) and Numeric Pain Rating Scale in patientswith shoulder pain

    JShoulder Elbow Surg


  • A. Minami et al.Modified Sauvé-Kapandji procedure for the distal radioulnar joint disorders of osteoarthritis and rheumatoid arthritis

    JOrthop Sci


  • L. Sauvé et al.

    Nouvelle technique de traitement chirurgical des luxations récidivantes isolées de l'extrémité inférieure du cubitus [in French]

    JChir (Paris)


    (Video) Session 3 Part 2

  • Z. Guo et al.

    Modified Sauve-Kapandji procedure for patients with old fractures of the distal radius

    Open Med


  • T.W. Jacobsen et al.

    The Sauvé-Kapandji procedure for posttraumatic disorders of the distal radioulnar joint

    Acta Orthop Belg


  • P.B. Carter et al.

    The Sauve-Kapandji procedure for post-traumatic disorders of the distal radio-ulnar joint

    JBone Joint Surg Br


  • D.M. Lamey et al.

    Results of the modified Sauvé-Kapandji procedure in the treatment of chronic posttraumatic derangement of the distal radioulnar joint

    JBone Joint Surg Am


  • Cited by (8)

    View all citing articles on Scopus

    Recommended articles (6)

    • Research article

      Factors Associated With Reoperation and Conversion to Wrist Fusion After Proximal Row Carpectomy or 4-Corner Arthrodesis

      The Journal of Hand Surgery, Volume 45, Issue 2, 2020, pp. 85-94.e2

      Proximal row carpectomy (PRC) and 4-corner arthrodesis (FCA) are common salvage procedures for the treatment of scapholunate advanced collapse and scaphoid nonunion advanced collapse. This study aimed to assess rates of reoperation and conversion to wrist fusion and to assess the factors associated with reoperation and conversion to wrist fusion for patients treated with PRC and FCA.

      A retrospective chart review was performed evaluating 266 adult patients undergoing PRC or FCA at a single institutional system from 2002 to 2016. Demographic data, patient- and injury-specific data, reoperation and conversion rates, and complications were collected. Potential factors associated with reoperation or wrist fusion were evaluated using a bivariate, followed by a multivariable, analysis.

      Reoperation was more commonly performed in FCA (34%) than in PRC (11%) (odds ratio [OR], 3.4; 95% confidence interval [95% CI], 1.7–6.8) and occurred at a shorter postoperative interval. In a multivariable analysis for reoperation, manual labor was associated with reoperation in patients undergoing FCA (OR, 5.4; 95% CI, 1.5–19.1). In those undergoing PRC, anterior interosseous nerve (AIN) and/or posterior interosseous nerve (PIN) neurectomy was associated with a lower rate of reoperation (OR, 0.18; 95% CI, 0.06–0.57). In a multivariable analysis for conversion to wrist arthrodesis, intraoperative AIN and/or PIN neurectomy (OR, 0.18; 95% CI, 0.06–0.57) was associated with a lower rate of conversion to wrist fusion, and smoking (OR, 4.9; 95% CI, 1.8–13.5) was associated with a higher rate of conversion to wrist fusion. In the subanalysis of patients who underwent PRC, only AIN and/or PIN neurectomy was associated with lower rates of conversion to wrist arthrodesis (OR, 0.15; 95% CI, 0.04–0.56).

      In our cohort, we observed that AIN and/or PIN neurectomy reduced the risk of reoperation and conversion to wrist arthrodesis after PRC. Smoking increased the odds of conversion to wrist arthrodesis in the combined PRC/FCA cohort; however, it is unclear whether this was due to smoking itself or whether the indications for PRC or FCA were affected, leading to this result.

      Prognostic IV.

    • Research article

      Reconstruction of Finger Pulp Defects With an Innervated Distally-Based Neurovascular Flap

      The Journal of Hand Surgery, Volume 45, Issue 5, 2020, pp. 454.e1-454.e8

      Finger pulp resurfacing is a challenging reconstructive problem. This article introduces sensory reconstruction of finger pulp defects using an innervated distally-based neurovascular flap raised from the dorsum of the thumb.

      From May 2015 to May 2017, the innervated distally-based neurovascular flap was used in 36 patients. The mean age at surgery was 37 years (range, 18–61 years). All patients were assessed using the total active motion (TAM) scoring system of the American Society for Surgery of the Hand. The sensitivity of the flap was tested using static 2-point discrimination.

      Full flap survival was achieved in 35 cases. Partial necrosis at the distal margin of the flap was observed in 1 case. At the final follow-up (mean, 20 months; range, 18–23 months), the mean TAM of the thumb was 206° (range, 188°–238°), including 8 excellent and 28 good results. The mean TAM of fingers was 266° (range, 251°–282°), including 4 excellent and 32 good results. The mean value of static 2-point discrimination was 5 mm (range, 4–7 mm) in the flap, including 31 excellent and 5 good results.

      The innervated distally-based neurovascular flap raised from the dorsum of the thumb is a reliable alternative for sensory reconstruction of finger pulp defects.

      Therapeutic IV.

    • Research article

      Palmar Radiocarpal Artery Vascularized Bone Graft for the Unstable Humpbacked Scaphoid Nonunion With an Avascular Proximal Pole

      The Journal of Hand Surgery, Volume 45, Issue 4, 2020, pp. 298-309

      The most challenging scaphoid nonunion is the unstable nonunion with humpbacked collapse coupled with an avascular proximal pole. Dorsal distal radius pedicled vascularized bone grafts (VBGs) are contraindicated in cases of humpback deformity. The free medial femoral condyle VBG is an excellent option but it is an extensive microsurgical procedure with lengthy operative times and dual-limb incisions. In search of a local, volar, vascularized source of bone to treat this challenging subset of scaphoid nonunions, we analyzed our results with a volar distal radius bone graft based on the pedicled palmar radiocarpal artery (PRCA).

      A prospective cohort of 15 unstable nonunions with avascular proximal pole fragments was treated with the PRCA graft and open reduction internal fixation. Preoperative carpal indices revealed a high degree of instability. All 15 lacked punctate bleeding from the proximal pole. All 15 patients were treated with the PRCA VBG technique and scanned with computed tomography at approximately 6 and 12 weeks to assess for interval healing.

      All nonunions healed with an average cross-sectional trabeculation score of 70% at week 6and 84% at week 12. Sagittal intrascaphoid angles improved from 50° to 27°, radiolunate angle improved from –20° to –7°, scapholunate angle improved from 86° to 64°, and revised carpal height ratio improved from 1.45 to 1.53, indicating correction of the humpback collapse deformity. Patients were observed an average of 22 months to have no sign of further avascular necrosis.

      Pedicled PRCA–VBG successfully addresses the dual needs of the humpbacked scaphoid nonunion with an avascular proximal pole while simultaneously limiting dissection to one limb and avoiding the additional complexities of free tissue transfer.

      Therapeutic II.

      (Video) Kapandji Intrafocal Pinning
    • Research article

      Successful Digital Revascularization in a Patient With Factor V Leiden Mutation

      The Journal of Hand Surgery, Volume 45, Issue 5, 2020, pp. 458.e1-458.e3

      Replantation/revascularization involves microsurgical anastomosis of the digital arteries and veins, which are often 2 mm or less in diameter. Thrombosis is a known risk of revascularization that ultimately can lead to ischemic digital loss. Factor V Leiden mutation is present in 3% to 8% of the population and results in generalized hypercoagulability. We present the case of a single-digit revascularization that was successful following vein grafting in a patient with factor V Leiden mutation.

    • Research article

      Multicentric Reticulohistiocytosis: Elective Excision of Symptomatic Hand Nodules With 1-Year Follow-Up

      The Journal of Hand Surgery, Volume 45, Issue 5, 2020, pp. 457.e1-457.e5

      Multicentric reticulohistiocytosis is a rare non–Langerhans cell histiocytic rheumatologic disorder characterized by multiple skin lesions, painful hand nodules, and destructive polyarthritis that results in arthritis mutilans in 20% to 30% of patients. In the current literature, there have been approximately 300 cases reported and the pathogenesis remains unclear. Currently, there is no diagnostic serologic test and no consensus on management. In this case report, we present a patient with multicentric reticulohistiocytosis who was treated with selective excision of 3 painful nodules on the hand. The patient was seen 1 year after surgery. One of the nodules reoccurred whereas the other 2 remained quiescent. This procedure has the potential to produce considerable pain relief and improve quality of life in a disease process for which optimal medical regimen remains to be determined.

    • Research article

      Nerve Versus Tendon Transfer for Radial Nerve Paralysis Reconstruction

      The Journal of Hand Surgery, Volume 45, Issue 5, 2020, pp. 418-426

      With radial nerve lesions, the results of nerve transfers and how they objectively compare with the outcomes of tendon transfers remain unstudied. We compared the results after nerve transfer in patients with less than 12 months since radial nerve injury with the results after tendon transfer in patients not eligible for nerve surgery because of longstanding paralysis (minimum of 15 months).

      In 14 patients with radial nerve lesions incurred less than 12 months previously, we transferred the anterior interosseous nerve to the nerve of the extensor carpi radialis brevis (ECRB), while the nerve to the flexor carpi radialis was transferred to the posterior interosseous nerve. In 13 patients with lesions of longer duration, we transferred the pronator teres tendon to the ECRB, the flexor carpi ulnaris tendon to the extensor digitorum communis, and the palmaris longus to the rerouted extensor pollicis longus (EPL) tendon. At a final evaluation, we measured passive and active range of motion (ROM) of the wrist, finger, and thumb and grasp strength.

      In a comparison of wrist flexion-extension ROM and grasp strength, we observed better recovery in the nerve transfer than in the tendon transfer group. In the tendon transfer group, we observed limitations in wrist flexion in 9 of the 13 patients and permanent radial deviation in 5. Half of the patients in the tendon transfer group needed to flex their wrist to fully extend their fingers, whereas finger extension was possible with the wrist either extended or at neutral in all patients following nerve transfer. After nerve transfer, extension at the first carpometacarpal joint was restored in 11 of the 14 patients, whereas this occurred in just 4 of the 13 patients following tendon transfer. In both groups, we observed a 30° lag in thumb metacarpophalangeal extension, which reflects poor recovery of EPL function.

      Overall, we observed better outcomes in those who underwent nerve transfer versus tendon transfer procedures. However, room still remains for improved thumb motion with both procedures.

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

      Therapeutic IV.

    View full text

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


    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.


    1. Post-distal radius fracture - conservatively-managed
    2. DRUJ replacement by Dr Luis Scheker
    (Pulvertaft Videos)
    3. Unstable DRUJ (Prof. David Warwick )
    (Benha scientific orthotube channel)
    4. Hand and Wrist Arthritis - ABOS Orthopedic Surgery Board Exam Review
    5. Patología degenerativa de articulación radiocubital distal
    (Ortopedia y Traumatología FSFB)
    6. Journal of Hand and Microsurgery presents *Webinar on DRUJ / TFCC Injuries
    (Ortho TV : Orthopaedic Video Channel)
    Top Articles
    Latest Posts
    Article information

    Author: Twana Towne Ret

    Last Updated: 02/02/2023

    Views: 6283

    Rating: 4.3 / 5 (64 voted)

    Reviews: 95% of readers found this page helpful

    Author information

    Name: Twana Towne Ret

    Birthday: 1994-03-19

    Address: Apt. 990 97439 Corwin Motorway, Port Eliseoburgh, NM 99144-2618

    Phone: +5958753152963

    Job: National Specialist

    Hobby: Kayaking, Photography, Skydiving, Embroidery, Leather crafting, Orienteering, Cooking

    Introduction: My name is Twana Towne Ret, I am a famous, talented, joyous, perfect, powerful, inquisitive, lovely person who loves writing and wants to share my knowledge and understanding with you.