scholarly journals Functional and Radiographic Outcomes of the Sauvé-Kapandji and Darrach Procedures in Rheumatoid Arthritis

2018 ◽  
Vol 11 (02) ◽  
pp. 071-079 ◽  
Author(s):  
Hannah M. Carl ◽  
Scott D. Lifchez
Keyword(s):  
Rheumatoid Arthritis ◽  
Range Of Motion ◽  
Average Length ◽  
Distal Radioulnar Joint ◽  
Functional Improvement ◽  
Single Institution ◽  
Radioulnar Joint ◽  
Radiographic Outcomes ◽  
Radiocarpal Joint

Abstract Background Deterioration of the distal radioulnar joint (DRUJ) in rheumatoid arthritis (RA) manifests as pain, weakness, and reduced range of motion. The Darrach and Sauvé-Kapandji (S-K) procedures are used when medical management fails to control these symptoms. However, there is a paucity of literature comparing the outcomes of these procedures. The purpose of this study is to compare the clinical and radiographic outcomes of the Darrach and S-K procedures in RA patients. Materials and Methods This is a retrospective, single institution cohort study of RA patients who underwent the Darrach or S-K procedure between 2008 and 2016. Ulnar translation, range of motion, and functional improvement were compared. Results Nine patients (13 wrists) underwent the Darrach procedure, and nine patients (11 wrists) underwent the S-K procedure. The average length of follow-up was 1.3 years. Pain, function, and range of motion improved in both groups. The degree of ulnar translation did not significantly change after either procedure. Conclusion Given their similar outcomes, we found no evidence that the S-K procedure is superior to the Darrach procedure or vice versa. However, when surgery is indicated for younger RA patients with DRUJ disease and ulnar translation, the S-K may be better suited to prevent radiocarpal joint dislocation.

RADIOLUNATE FUSION WITH DISTRACTION USING CORTICOCANCELLOUS BONE GRAFT FOR MINIMIZING DECREASE OF WRIST MOTION IN RHEUMATOID WRISTS

Hand Surgery ◽  
2009 ◽  
Vol 14 (01) ◽  
pp. 15-21 ◽  
Author(s):  
Tatsuya Masuko ◽  
Norimasa Iwasaki ◽  
Jun-ichi Ishikawa ◽  
Hiroyuki Kato ◽  
Akio Minami
Keyword(s):  
Rheumatoid Arthritis ◽  
Bone Graft ◽  
Range Of Motion ◽  
Clinical Evaluation ◽  
Radiological Assessment ◽  
Wrist Flexion ◽  
Wrist Motion ◽  
Fusion Procedure ◽  
Radiocarpal Joint

Radiolunate fusion is a limited carpal fusion procedure used for patients with rheumatoid arthritis. However, this procedure inevitably causes decreases in range of motion, especially wrist flexion. Linscheid and Dobyns described the possibility of minimizing the decrease in motion at the radiocarpal joint by slight distraction of the joint. We hypothesized for our modified procedure that a corticocancellous bone graft was inserted between the radius and the lunate with a small amount of over-correction could provide slight distraction of radioscaphoid joint and protect the joint from decreased range of motion after arthrodesis. Twelve wrists in ten patients with rheumatoid arthritis underwent radiolunate fusion. Mean age at operation was 53 years old and mean follow-up period was 5.7 years. Clinical evaluation and radiological assessment showed that decrease in range of motion was minimized compared with other procedures. Because our modified procedure can minimize decrease in motion, it is recommended.

scholarly journals High power Doppler ultrasound score is associated with the risk of triangular fibrocartilage complex (TFCC) tears in severe rheumatoid arthritis

2018 ◽  
Vol 67 (2) ◽  
pp. 327-330
Author(s):  
Jen-Hung Chen ◽  
Kuo-Chin Huang ◽  
Chung-Cheng Huang ◽  
Han-Ming Lai ◽  
Wen-Yi Chou ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Logistic Regression ◽  
Power Doppler ◽  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
The Body ◽  
Radiocarpal Joint ◽  
Triangular Fibrocartilage ◽  
Ultrasound Score

In the distal radioulnar joint, the triangular fibrocartilage complex (TFCC) is an important stabilizer and are frequently found in patients with rheumatoid arthritis (RA) with wrist pain. This study was designed to predict TFCC tears using high-resolution ultrasound in severe RA. We retrospectively reviewed patients with severe RA. MRI and ultrasound were performed at baseline and after 1 year of follow-up. TFCC tears were recorded. The predictive factors for TFCC tears were analyzed by logistic regression. During the 1-year follow-up period, 54 patients were enrolled (42 females and 12 males), of whom 21 (38.9%) developed TFCC tears. The body mass index was 22.81±2.59 kg/m2 in the TFCC tear group compared with 23.61±2.76 kg/m2 in the non-tear group (p=0.136). The mean age was 55.14±9.54 years in the TFCC tear group compared with 56.45±14.04 years in the non-tear group (p=0.596). The tear group had a higher Disease Activity Score in 28 joints (DAS28) (6.36±0.47 vs 5.58±0.65, p=0.011) and higher power Doppler (PD) ultrasound score at the dorsal radiocarpal joint (1.90±1.30 vs 1.33±0.99, p=0.011) than the non-tear group. We found that high DAS28 (OR 2.96, 95% CI 1.95 to 4.50; p=0.001) and higher baseline PD score (OR 1.51, 95% CI 1.07 to 2.14; p=0.019) were significantly associated with a higher risk of TFCC tears by logistic regression. So we conclude a higher wrist PD score in severe RA predicted future TFCC tears. Therefore, we suggest to use PD score in such patients to monitor the risk of future TFCC tears.

scholarly journals Radius' Giant Cell Tumor: Allograft with Conservation of Distal Radioulnar Joint

2019 ◽  
Vol 08 (03) ◽  
pp. 215-220 ◽  
Author(s):  
S. Ruatti ◽  
M. Boudissa ◽  
P. Grobost ◽  
G. Kerschbaumer ◽  
J. Tonetti
Keyword(s):  
Range Of Motion ◽  
Giant Cell Tumor ◽  
Giant Cell ◽  
Distal Radius ◽  
Functional Results ◽  
Distal Radioulnar Joint ◽  
Cell Tumor ◽  
The Other ◽  
Radioulnar Joint

Purpose Giant cell tumor of the distal radius are frequent lesions, and different types of surgeries have been described. Functional results, after conservative treatment or arthrodesis, often find a decreased strength and range of motion. The sacrifice of the distal radioulnar joint could be one of the causes. We report the case of a 26-year-old patient who presented with a Campanacci Grade III giant cell tumor of the distal radius. We managed his case by the association of en bloc resection and allograft reconstruction with the preservation of distal radioulnar joint. Hypothesis This procedure could improve functional results, without increasing the risk of recurrence at 2 years follow-up. Case Report The originality of our technique was the possibility of distal radioulnar joint conservation. We preserved a long portion of cortex bone all through the ulnar side of the distal radius. We then used an allograft of distal radius, fixed by a reconstruction anatomical plate. Results At 2 years follow-up, the range of motion was 100° with 60° of palmar flexion, 40° of extension, 75° of pronation, and 70° of supination. Radial and ulnar inclination were 10 and 15°, respectively. MTS (Musculoskeletal Tumor Society Score) 1993 was 88% and DASH score was 6. Concerning grip strength, it was measured at 85% in comparison with the other side. Pronation and supination strengths were 80 and 73%, respectively, in comparison with the other side. At follow-up, standard X-rays showed no recurrence. The allograft was well integrated. Conclusion Conservative treatment of the distal radioulnar joint allowed an almost ad integrum recovery, concerning strengths and range of motion. It allows a better functional recovery, without increasing the risk of recurrence.

MODIFIED MATCHED ULNAR RESECTION FOR ARTHROSIS OF DISTAL RADIOULNAR JOINT IN RHEUMATOID ARTHRITIS

Hand Surgery ◽  
2006 ◽  
Vol 11 (01n02) ◽  
pp. 15-19 ◽  
Author(s):  
K. N. Srikanth ◽  
S. A. Shahane ◽  
J. H. Stilwell
Keyword(s):  
Rheumatoid Arthritis ◽  
Retrospective Study ◽  
Pain Relief ◽  
Distal Radius ◽  
Distal Radioulnar Joint ◽  
Rheumatoid Patient ◽  
Radioulnar Joint ◽  
Ulnar Head

The pain of distal radioulnar arthrosis in rheumatoid patients is often due to disease largely confined to the radioulnar rather than the ulnocarpal articulation. This is a retrospective study of 14 patients (14 wrists) who underwent selective shaving of the radial articulation of the ulnar head leaving the ulnocarpal articulation intact. The ulnar head is reduced to the circumference of its shaft and a dorsal retinacular flap is interposed between it and the distal radius. Average age of the patients and follow-up were 63.5 years and 31 months, respectively. All patients had rheumatoid arthritis. Pain improved in 14 out of 15 wrists. Overall results were 67% good to excellent and 33% fair based on the modified Mayo's wrist score. This novel procedure for DRUJ arthrosis produces predictable pain relief in low demand rheumatoid patient.

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

Open Medicine ◽  
2017 ◽  
Vol 12 (1) ◽  
pp. 417-423 ◽  
Author(s):  
Zhitao Guo ◽  
Yuli Wang ◽  
Yacong Zhang
Keyword(s):  
Distal Radius ◽  
Functional Limitations ◽  
Distal Radioulnar Joint ◽  
Posttraumatic Arthritis ◽  
Salvage Procedure ◽  
Score System ◽  
Radioulnar Joint ◽  
Radiographic Outcomes ◽  
Time Of Admission

AbstractObjectiveTo evaluate the clinical and radiographic outcomes of a modified Sauve-Kapandji procedure for patients with old fractures in the distal radius.MethodsFifteen patients (10 male and 5 female patients with an average age of 40 years old) were treated by the modified Sauve-Kapandji procedure from January 2014 to April 2016. All patients had undergone at least one previous operation on the involved wrist, and they were still suffering from pain and functional limitations at the time of admission. The postoperative follow-up period was 12-26 months and the average was 20 months. Functional assessment was made at the last follow-up. All patients were evaluated according a Modified Mayo Wrist Score system.ResultsOf the fifteen patients with posttraumatic arthritis, thirteen had excellent results, two had good results, and one had fair results. There were no major complications.ConclusionsThe modified Sauve-Kapandji procedure is a safe and effective surgical alternative for intractable disorders of the distal radioulnar joint and can be recommended as a salvage procedure when previous treatments fail.

Sauve-Kapandji Remains a Viable Option for Distal Radioulnar Joint Dysfunction

Hand ◽  
2020 ◽  
pp. 155894472096672
Author(s):  
Nicholas Munaretto ◽  
William Aibinder ◽  
Steven Moran ◽  
Marco Rizzo
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Distal Radioulnar Joint ◽  
High Rate ◽  
Wrist Flexion ◽  
Level Of Evidence ◽  
Radioulnar Joint ◽  
Major Complications ◽  
The Mean

Introduction Dysfunction of the distal radioulnar joint (DRUJ) can be significantly debilitating. The Sauve-Kapandji (S-K) procedure can be indicated to address multiple etiologies of DRUJ dysfunction. The purpose of this study was to review our institution’s results performing the S-K procedure for DRUJ dysfunction in terms of clinical and radiographic outcomes, as well as complications and reoperations. Methods A retrospective review of S-K procedures performed at 2 institutions between 1998 and 2017 with a minimum of 1-year follow-up was performed. Preoperative and postoperative visual analog scale (VAS) pain, grip strength, and wrist range of motion were reviewed. Radiographs were reviewed for DRUJ healing, carpal translation, and radiocarpal degenerative changes. Results The cohort included 35 patients. The mean age was 51 years. The mean follow-up was 49.5 months. The postoperative range of motion was unchanged in regard to pronation, supination, and wrist extension. There was a decrease in wrist flexion from 43 degrees to 34 degrees. Successful union was noted in 100% of the wrists. There was 1 case (2.8%) of progressive ulnar translation and 4 major complications (11.3%). Conclusion The S-K procedure has several theoretical benefits compared to other procedures for DRUJ dysfunction with results of this study demonstrating excellent pain relief, improved postoperative grip strength, retained wrist pronation, supination, and extension, high rate of successful arthrodesis and low rate of major complications. Level of Evidence Level IV

Comparative Results of Resection of the Distal Ulna in Rheumatoid Arthritis and Post-Traumatic Conditions

1999 ◽  
Vol 24 (6) ◽  
pp. 667-670 ◽  
Author(s):  
K. E. FRASER ◽  
E. DIAO ◽  
C. A. PEIMER ◽  
F. S. SHERWIN
Keyword(s):  
Rheumatoid Arthritis ◽  
Pain Relief ◽  
Range Of Motion ◽  
Grip Strength ◽  
Distal Radioulnar Joint ◽  
Distal Ulna ◽  
Radioulnar Joint ◽  
Post Traumatic ◽  
Comparative Results ◽  
Trauma Group

The purpose of this study was to determine whether the results of resection of the distal ulna differed depending upon the underlying aetiology of the condition. Patients with rheumatoid arthritis were compared with patients with post-traumatic wrist complaints. Fifty resections in 40 patients (eight male, 32 female) were assessed with respect to pain, range of motion, and grip strength. Of the 23 rheumatoid wrists, 86% were pain-free following surgery; however, only 36% of the patients in the trauma group reported pain relief postoperatively. Pain relief in posttraumatic patients was more predictable when distal radioulnar joint arthrosis was identified as the sole cause of wrist pain.

scholarly journals Functional outcomes after modified Sauve-Kapandji arthrodesis for distal radioulnar joint dysfunction

2021 ◽  
Vol 7 (2) ◽  
pp. 303
Author(s):  
Hiranya Kumar Seenappa ◽  
Karthik Narayanamurthy Mittemari ◽  
Shivaraj Nadagouda ◽  
Vamshikrishna Chand Nimmagadda
Keyword(s):  
Range Of Motion ◽  
Clinical Outcomes ◽  
Functional Assessment ◽  
Functional Outcomes ◽  
Distal Radioulnar Joint ◽  
Analog Scale ◽  
Distal Ulna ◽  
Excellent Outcome ◽  
Radioulnar Joint

<p><strong>Background: </strong>The distal radioulnar joint (DRUJ) dysfunction manifests as pain, weakness and reduced range of motion<strong>. </strong>There are various treatments for DRUJ dysfunction. Modified Sauvé-Kapandji procedure involves arthrodesis of the distal radioulnar joint combined with the creation of a pseudarthrosis of the distal ulna to maintain forearm pronation and supination, and stabilization of proximal ulnar stump. This study was performed to evaluate the clinical outcomes of modified Sauve-Kapandji procedure for patients with DRUJ dysfunction.</p><p><strong>Methods: </strong>Fourteen patients with DRUJ dysfunction were treated by modified Sauve-Kapandji procedure and followed up for 2 years post-operatively. Functional assessment was evaluated according to modified mayo wrist score (MMWS) system and severity of pain by visual analog scale. Posteroanterior and lateral radiographs were used to assess fusion.</p><p><strong>Results: </strong>There was a significant improvement in VAS of wrist pain (p&lt;0.001) and MMWS (p&lt;0.001) at 2 years follow up. Excellent outcome was reported in 64.3% (n=9) patients. Radiographic fusion was seen in all 14 cases.</p><p><strong>Conclusions: </strong>The modified<strong> </strong>Sauve-Kapandji procedure for DRUJ dysfunction is a safe and effective procedure with excellent radiological fusion and significant improvement in functional outcomes.</p><p><strong> </strong></p>

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

2020 ◽  
Author(s):  
Tomoyuki Kato ◽  
Taku Suzuki ◽  
Makoto Kameyama ◽  
Masato Okazaki ◽  
Yasushi Morisawa ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Tendon Rupture ◽  
Extensor Tendon ◽  
Distal Radioulnar Joint ◽  
Wrist Flexion ◽  
Level Of Evidence ◽  
Radioulnar Joint ◽  
The Mean ◽  
Therapeutic Study ◽  
Loss Of Motion

Abstract Background Previous study demonstrated that distal radioulnar joint (DRUJ) plays a biomechanical role in extension and flexion of the wrist and suggested that fixation of the DRUJ could lead to loss of motion of the wrist. Little is known about the pre- and postoperative range of motion (ROM) after the Sauvé–Kapandji (S-K) and Darrach procedures without tendon rupture. To understand the accurate ROM of the wrist after the S-K and Darrach procedures, enrollment of patients without subcutaneous extensor tendon rupture is needed. Purpose This study aimed to investigate the pre- and postoperative ROM after the S-K and Darrach procedures without subcutaneous extensor tendon rupture in patients with rheumatoid arthritis (RA) and osteoarthritis (OA). Methods This retrospective study included 36 patients who underwent the S-K procedure and 10 patients who underwent the Darrach procedure for distal radioulnar joint disorders without extensor tendon rupture. Pre- and postoperative ROMs after the S-K and Darrach procedures were assessed 1 year after the surgery. Results In the S-K procedure, the mean postoperative ROM of the wrist flexion (40 degrees) was significantly lower than the mean preoperative ROM (49 degrees). In wrist extension, there were no significant differences between the mean preoperative ROM (51 degrees) and postoperative ROM (51 degrees). In the Darrach procedure, the mean postoperative ROM of the wrist flexion and extension increased compared with the mean preoperative ROM; however, there were no significant differences. Conclusion In the S-K procedure, preoperative ROM of the wrist flexion decreased postoperatively. This study provides information about the accurate ROM after the S-K and Darrach procedures. Level of Evidence This is a Level IV, therapeutic study.

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