Background: The Sauvé-Kapandji procedure has become popular
for the treatment of disorders of the distal radioulnar joint in patients with
rheumatoid arthritis, but this procedure is impossible to perform in patients
with poor bone quality in the distal part of the ulna. We have modified the
procedure for patients with poor bone quality in the distal part of the ulna.
The modified procedure involves resecting the distal part of the ulna, making
a drill-hole in the ulnar cortex of the distal part of the radius, rotating
the resected portion of the ulna 90°, inserting it into the distal part of
the radius, and fixing it at that site with use of an AO cancellous-bone
screw. In the present report, we describe the new operative technique and
report the results after a minimum duration of follow-up of three years.
Methods: This operation was performed in fifty-six patients
(sixty-six wrists) with rheumatoid arthritis. The mean age at the time of the
operation was 59.3 years. The mean duration of follow-up was forty-eight
months. Patients were evaluated in terms of wrist pain, grip strength, and
range of motion. Radiographic evaluation included calculation of the carpal
translation index to assess the extent of ulnar translation of the carpus.
Results: Osseous union was achieved in all cases. Wrist pain
resolved or decreased in all patients. The mean total range of forearm
rotation increased from 144° preoperatively to 167° at the time of the
most recent follow-up (p < 0.01). The mean carpal translation index did not
change after the operation.
Conclusions: The modified Sauvé-Kapandji procedure results in
rigid fixation of the grafted bone. The technique provides sufficient osseous
support of the carpus even in patients with rheumatoid arthritis and poor bone
quality in the distal part of the ulna.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.