Surgical Techniques   |    
Modified Sauvé-Kapandji Procedure for Disorders of the Distal Radioulnar Joint in Patients with Rheumatoid Arthritis
Satoru Fujita, MD1; Kazuhiro Masada, MD2; Eiji Takeuchi, MD3; Masataka Yasuda, MD3; Yoshio Komatsubara, MD4; Hideo Hashimoto, MD3
1 Department of Orthopaedic Surgery, Takarazuka Dai-ichi Hospital, 19-5 Kougetsu-cho, Takarazuka, Hyogo 665-0832, Japan
2 Masada Clinic, 201 Shin-Kanaoka Building, 779-2 Nagasone-cho, Sakai, Osaka 591-8025, Japan. E-mail address: seikeigeka@masada.ptu.jp
3 Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Sakai, Osaka 591-8025, Japan
4 Department of Orthopaedic Surgery, Yukioka Hospital, 2-2-3 Ukita-cho, Kita-ku, Osaka 530-0021, Japan
View Disclosures and Other Information
The original scientific article in which the surgical technique was presented was published in JBJS Vol. 87-A, pp. 134-139, January 2005
The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
The line drawings in this article are the work of Joanne Haderer Müller of Haderer & Müller (biomedart@haderermuller.com).
Investigation performed at Osaka Rosai Hospital, Osaka, Japan

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 Mar 01;88(1 suppl 1):24-28. doi: 10.2106/JBJS.E.01073
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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.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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