Stabilization of the Proximal Ulnar Stump in the Sauvé-Kapandji Procedure by Using the Extensor Carpi Ulnaris Tendon: Long-Term Follow-Up Studies

Abstract

1 ABSTRACTPurpose: The Sauvé-Kapandji (S-K) procedure is considered a useful treatment option for distal radioulnar disorders. However, postoperative instability of the proximal ulnar stump and radioulnar convergence may be symptomatic. We modified the Sauvé-Kapandji procedure by stabilizing the proximal ulnar stump with a half-slip of the extensor carpi ulnaris tendon. We previously reported 13 patients with this procedure at an average Conclusions: Our results in this paper suggested that the clinical radiographic results at the 35-month follow-up were maintained in the long-term 95-month follow-up despite the finding that the hole in the proximal ulnar stump had broken in three wrists at follow-up.2

Assessment and Treatment of Extensor Carpi Ulnaris Tendon Pathology

“…At the time of the latest follow-up, pain was found to be moderate in one patient, mild in three patients, and absent in eight patients 39 . Three patients had broken drill-holes in the proximal ulnar stump; however, there was no related proximal ulnar instability 39 .…”

“…This strip is then passed through the drill-hole and is retrieved from the medullary canal, is tensioned, and then is sutured back on itself 36 . A retrospective review of twelve patients followed for an average of ninety-five months revealed improved pain, range of motion, and grip strength at thirty-five months, which was maintained at ninety-five months 39 . At the time of the latest follow-up, pain was found to be moderate in one patient, mild in three patients, and absent in eight patients 39 .…”

“…A retrospective review of twelve patients followed for an average of ninety-five months revealed improved pain, range of motion, and grip strength at thirty-five months, which was maintained at ninety-five months 39 . At the time of the latest follow-up, pain was found to be moderate in one patient, mild in three patients, and absent in eight patients 39 . Three patients had broken drill-holes in the proximal ulnar stump; however, there was no related proximal ulnar instability 39 .…”

The Sauvé-Kapandji Procedure

“…Stump pain, feelings of instability of the ulnar shaft proximal to the resection level, and impingement of the ulnar shaft against the radius have all been reported. 11,16 Generally, symptoms from those problems resolve by 3 months after surgery. Notable instability of the ulnar shaft is more often a problem after resection of the distal ulna (Darrach procedure).…”

“…Nonetheless, painful instability of the distal ulnar shaft can occur, but if this rare situation does develop, the stump can be stabilized with a strip of the extensor carpi ulnaris tendon based on its distal insertion as previously described for treating the same problem after a failed Darrach procedure. 16 Ossification of the intended pseudarthrosis site is another potential complication of the Sauvé-Kapandji procedure. Interposition of the pronator quadratus into : Illustrative case of a patient who had a malunion of fractures of the distal radius and ulnar head, which resulted in deformity of the DRUJ and complete loss of forearm supination.…”