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

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.

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Radius distraction could contribute to long-term stability for treating distal radioulnar joint instability during volar plating of distal radius fracture: a retrospective case series study

10.21203/rs.3.rs-617556/v1 ◽

2021 ◽

Author(s):

Cheng-Yu Yin ◽

Hui-Kuang Huang ◽

Duretti Fufa ◽

Jung-Pan Wang

Keyword(s):

Surgical Technique ◽

Distal Radius Fracture ◽

Distal Radius ◽

Case Series ◽

Distal Radioulnar Joint ◽

Radius Fracture ◽

Radioulnar Joint ◽

Druj Instability

Abstract BackgroundThe surgical technique of radius distraction for stabilization of distal radioulnar joint (DRUJ) if intraoperative DRUJ instability was found after the fixation of distal radius fracture has been previously described, but this surgical technique lacks clinical and radiographic effect in minimal 3 years follow-up. We therefore evaluated the clinical outcome and radiographic results of radius distraction in minimal 3 years follow-up.MethodsWe reviewed the case series of distal radius fracture with concomitant DRUJ instability receiving radius distraction from the senior author over a 5-year period (January 1st, 2013 to June 30th, 2017) retrospectively, and the evaluation of clinical and radiographic outcomes was performed at clinic as long-term follow-up; a total 34 patients had been evaluated.ResultsAt minimal post-operative 36 months follow-up, all cases demonstrated acceptable wrist range of motion with stable DRUJs and low NRS of wrist pain (0.6, SD 0.7) and DASH score (mean 9.1, SD 6.2), and there were no cases suffering from nonunion of distal radius. The mean ulnar variance of injured wrist and uninjured wrist were − 1.2 mm and 0.2mm, respectively (SD 1.0 and 0.6) with significant statistical difference.ConclusionsRadius distraction during volar fixation of distal radius fracture should be consider if DRUJ instability was found by the radioulnar stress test intraoperatively, and the long-term DRUJ stability could be achieved by maintenance of normal-to-negative ulnar variance, with decreased wrist pain and satisfactory function outcome.Level of EvidenceTherapeutic Level IV

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

Journal of Wrist Surgery ◽

10.1055/s-0039-1683364 ◽

2019 ◽

Vol 08 (03) ◽

pp. 215-220 ◽

Cited By ~ 1

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.

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

Hand Surgery ◽

10.1142/s0218810406003085 ◽

2006 ◽

Vol 11 (01n02) ◽

pp. 15-19 ◽

Cited By ~ 4

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.

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

Journal of Hand and Microsurgery ◽

10.1055/s-0038-1670926 ◽

2018 ◽

Vol 11 (02) ◽

pp. 071-079 ◽

Cited By ~ 1

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.

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THE SAUVÉ-KAPANDJI PROCEDURE IN COMBINATION WITH OPENING RADIAL WEDGE OSTEOTOMY FOR MALUNION OF DISTAL RADIUS FRACTURES

Hand Surgery ◽

10.1142/s0218810498000350 ◽

1998 ◽

Vol 03 (02) ◽

pp. 257-262

Author(s):

Yasunori Hattori ◽

Kazuteru Doi ◽

Noriyuki Kuwata ◽

Fujio Kawakami ◽

Ken Ohtuka

Keyword(s):

Distal Radius ◽

Severe Pain ◽

Distal Radioulnar Joint ◽

Distal Radius Fractures ◽

Wedge Osteotomy ◽

Radius Fractures ◽

Forearm Rotation ◽

Radiographic Evidence ◽

Radioulnar Joint

The Sauvé-Kapandji procedure in combination with an opening radial wedge osteotomy for malunion of distal radius fractures was performed in six patients. Follow-up at an average of 40.3 months showed two excellent, three good, and one poor result. Satisfactory results were obtained in restoration of forearm rotation and improvement of pain in all patients. The Sauvé-Kapandji procedure in addition to an opening radial wedge osteotomy was indicated when a preoperative limitation of forearm rotation with severe pain and radiographic evidence of degenerative changes in the distal radioulnar joint were present. We have found combining these two procedures to be a reliable treatment option for malunion of distal radius fractures.

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Salvage Procedure for Failed Bowers' Hemiresection Interposition Technique in the Distal Radioulnar Joint

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(98)80089-2 ◽

1998 ◽

Vol 23 (6) ◽

pp. 749-753 ◽

Cited By ~ 17

Author(s):

J. GONZALEZ DEL PINO ◽

D. L. FERNANDEZ

Keyword(s):

Bone Graft ◽

Joint Pain ◽

Distal Radioulnar Joint ◽

Resection Arthroplasty ◽

Salvage Procedure ◽

Radioulnar Joint ◽

Sigmoid Notch

Three patients who continued to have distal radioulnar joint pain following Bowers' hemiresection interposition technique were treated by converting the resection arthroplasty into a Sauvé-Kapandji procedure. The resected 10 mm segment from the distal ulnar metaphysis was used as an interposition bone graft in the arthrodesis site, placed between the sigmoid notch of the radius and distal end of the ulna. After a minimum follow-up of 3 years, all three patients were satisfied with the procedure, were pain-free, and the preoperative range of wrist and forearm motion had increased. All three returned to their previous working activities.

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Desmoid tumour of the distal forearm involving the distal radioulnar joint

BMJ Case Reports ◽

10.1136/bcr-2020-237097 ◽

2020 ◽

Vol 13 (11) ◽

pp. e237097

Author(s):

Apoorv Sehgal ◽

Pratyush Shahi ◽

Avijeet Prasad ◽

Manoj Bhagirathi Mallikarjunaswamy

Keyword(s):

Distal Radioulnar Joint ◽

Treatment Modalities ◽

Desmoid Tumour ◽

X Rays ◽

Distal Forearm ◽

Left Wrist ◽

Radioulnar Joint ◽

Magnetic Resonance Imaging Mri ◽

Epidemiology Investigation

A 32-year-old woman presented with progressive pain and swelling of the left wrist for 6 months. Physical examination revealed a firm, tender, oval swelling over the left wrist. X-rays showed a pressure effect on the distal radius and ulna. Magnetic Resonance Imaging (MRI) revealed a well-defined, asymmetrical, dumbbell-shaped soft-tissue lesion involving the interosseous region of the distal forearm and extending until the distal radioulnar joint (DRUJ). Core needle biopsy confirmed the diagnosis of desmoid tumour. Marginal excision of the tumour was done. At the 2-year follow-up, the patient was doing well and had painless and improved left wrist motion. Desmoid tumour involving the DRUJ has not been previously reported. We, through this case, report new observation and discuss the epidemiology, investigation of choice, treatment modalities, and the need for a regular follow-up for appendicular desmoid tumours.

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The rein-type arthroscopic capsular suture for triangular fibrocartilage complex foveal tears: midterm results for 90 patients

Journal of Hand Surgery (European Volume) ◽

10.1177/17531934211024177 ◽

2021 ◽

pp. 175319342110241

Author(s):

I-Ning Lo ◽

Kuan-Jung Chen ◽

Tung-Fu Huang ◽

Yi-Chao Huang

Keyword(s):

Simple Procedure ◽

Distal Radioulnar Joint ◽

Triangular Fibrocartilage Complex ◽

Joint Stability ◽

Level Of Evidence ◽

Radioulnar Joint ◽

High Satisfaction ◽

Ultrasound Assessment ◽

Triangular Fibrocartilage

We describe an arthroscopic rein-type capsular suture that approximates the triangular fibrocartilage complex to the anatomical footprint, and report the results at a minimum 12 month follow-up. The procedure involves two 3-0 polydioxanone horizontal mattress sutures inserted 1.5 cm proximal to the 6-R and 6-U portals to obtain purchase on the dorsal and anterior radioulnar ligaments, respectively. The two sutures work as a rein to approximate the triangular fibrocartilage complex to the fovea. Ninety patients with Type IB triangular fibrocartilage complex injuries were included retrospectively. The 12-month postoperative Modified Mayo Wrist scores, Disabilities of Arm, Shoulder and Hand scores and visual analogue scale for pain showed significant improvements on preoperative values. Postoperative range of wrist motion, grip strength and ultrasound assessment of the distal radioulnar joint stability were comparable with the normal wrist. The patients had high satisfaction scores for surgery. There were minor complications of knot irritation. No revision surgery for distal radioulnar joint instability was required. It is an effective and technically simple procedure that provides a foveal footprint contact for the triangular fibrocartilage complex. Level of evidence: IV

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Distal Radius Fracture Treatment Outcomes in Patients With Ipsilateral Hemiplegia or Hemiparesis

Hand ◽

10.1177/1558944721999733 ◽

2021 ◽

pp. 155894472199973

Author(s):

Nicholas Munaretto ◽

Adam Tagliero ◽

Raahil Patel ◽

Peter C. Rhee

Keyword(s):

Distal Radius Fracture ◽

Distal Radius ◽

Case Series ◽

Distal Radius Fractures ◽

Radius Fracture ◽

Functional Classification ◽

Radius Fractures ◽

Radiographic Outcomes ◽

Ipsilateral Hemiparesis

Background Little information exists to guide decision-making with regard to distal radius fractures in the setting of ipsilateral hemiparesis or hemiplegia. Methods Patients who sustained a distal radius fracture in the setting of ipsilateral hemiparesis or hemiplegia secondary to brain injury were evaluated. Investigated variables included perioperative pain, preinjury House functional classification score, length of immobilization, radiographic outcome measurements, and time to union. Results There were 15 patients with distal radius fractures with a mean age of 65.9 years. The mean clinical and radiographic follow-up was 2.8 and 2.9 years, respectively. Wrists were placed into the nonoperative group (NOG, n = 10) and operative group (OG, n = 5). Pain significantly decreased at final follow-up for both groups. Baseline House functional classification scores averaged 1.3 and 1.6 for the NOG and OG, respectively, and were maintained at final follow-up. Length of immobilization for the NOG was 46 days and OG was 37 days, P = .15. Radiographic outcomes at final follow-up in the NOG and OG, respectively, were a mean radial height of 9.3 versus. 11.6 mm, radial inclination of 18.3° versus 22.3°, 4.2° dorsal tilt versus 5.3° volar tilt, and tear drop angle of 45.6° versus 44.5°. There were no significant differences in these measurements. Time to radiographic union averaged 58 days for the NOG and 67 days for the OG, P = .42. There were no revision surgeries. Conclusions Based on this small case series, patients with distal radius fracture and ipsilateral hemiparesis or hemiplegia may have similar clinical, functional, and radiographic outcomes, regardless of nonoperative or operative treatment.

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In vivo measurement of distal radioulnar translation following distal radius fracture

Journal of Hand Surgery (European Volume) ◽

10.1177/17531934211016668 ◽

2021 ◽

pp. 175319342110166

Author(s):

Grey E. B. Giddins ◽

Greg T. Pickering

Keyword(s):

Distal Radius Fracture ◽

Distal Radius ◽

Distal Radioulnar Joint ◽

Wrist Fracture ◽

Radius Fracture ◽

Normal Range ◽

Radioulnar Joint ◽

In Vivo Measurement ◽

Objectively Measured

The incidence of distal radioulnar joint instability following a distal radius fracture is estimated around one in three based upon clinical examination. Using a validated rig, we objectively measured distal radioulnar joint translation in vivo following distal radius fracture. Dorsopalmar translation of the distal radioulnar joint was measured in 50 adults with previous distal radius fractures. Measurements were compared with the uninjured wrist and against a database of previous measurements within healthy and clinically lax populations. Translation at the distal radioulnar joint was greater in injured wrists at 12.2 mm (range 10–15, SD 1.2) than the uninjured wrists at 6.4 (range 4–9, SD 0.8) ( p < 0.001) and was always outside the established normal range. There was no statistically significant link between translation and the severity of the injury. Instability appears almost inevitable following a distal radius (wrist) fracture, albeit subclinical in the vast majority.

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