The short-term outcome of the modified Sauvé–Kapandji procedure regarding range of motion, carpal bone translation and bony shelf size

Abstract

The Sauvé-Kapandji (S-K) procedure is a common treatment for rheumatoid wrists, but in some cases severe bone destruction makes this operative modality difficult to perform, while also resulting in a poor outcome. A modified S-K procedure for these wrists has been reported, but the clinical outcomes of the modified procedure are unclear. This study evaluated 24 wrists in 20 patients who underwent the modified S-K procedure. The mean follow-up period was 34.5 months. The clinical assessments were range of motion, carpal bone translation and bony shelf size. The range of motion and carpal bone translation were similar to those produced by the S-K procedure. In regard to bony shelf size, wrists with an excessively large bony shelf tended to have a progression of carpal bone translation toward the palmar direction due to the residual malposition of the ECU tendon. The modified S-K procedure appears to be a safe and effective surgical alternative for the treatment of severely destroyed rheumatoid wrists. Although the modified procedure allows for the adjustment of the bony shelf size, it should not be used with wrists that have an excessively large bony shelf.

Range of Motion after the Sauvé–Kapandji and Darrach Procedures without Extensor Tendon Rupture

“…Our findings in the present study are consistent with previously reported data. [1][2][3][4][5][6][7][8][9] As described previously, there are two possible reasons for the postoperative decrease in wrist flexion. The most probable reason is dorsal soft tissue contracture caused by intra-articular invasion.…”

“…Many previous studies on the S-K procedure with extensor tendon repair evaluated the pre-and postoperative ROM of the wrist. [1][2][3][4][5][6][7] Most of the reports showed that ROM of wrist flexion decreases postoperatively, [1][2][3][4][5] whereas some of the reports showed a significant decrease. 6,7 To our knowledge, two previous studies evaluated ROM in the S-K procedure without extensor tendon rupture in OA patients and little is known about those in RA patients (►Table 3).…”

“…Postoperative ROM of the wrist extension increased in some studies, 1,2,4,5,8 and decreased in others. 3,6,7 Improvement of abutment of the distal ulna and decrease in ulnar pain could contribute to the increasing motion. Intra-articular invasion with postoperative immobilization or fixation of the DRUJ might decrease wrist extension.…”

“…On the contrary, many previous reports showed that the arc of wrist motion, especially in wrist flexion, does not improve or decreases postoperatively. [1][2][3][4][5][6][7][8][9] The reason why the arc of wrist motion worsens after the S-K procedure is not fully understood. Some possible reasons for dorsal soft tissue contracture caused by intra-articular invasion of the wrist are as follows: synovectomy, extensor tendon adhesion due to duration of postoperative immobilization of the wrist, or fixation of the DRUJ with a screw.…”

“…Therefore, little is known about the pre-and postoperative ROM after the S-K procedure without tendon rupture, especially in RA patients, while many studies have reported ROM with tendon rupture. [1][2][3][4][5][6][7][8][9] Furthermore, comparison of pre-and postoperative ROM between the S-K and Darrach procedures without tendon rupture has not been discussed widely.…”