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Darrach vs. Sauve-Kapandji: A Comprehensive Meta-Analysis of Surgical Outcomes in Distal Radioulnar Joint (DRUJ) Dysfunction. Indian J Orthop 2023; 57:565-570. [PMID: 37006734 PMCID: PMC10050530 DOI: 10.1007/s43465-023-00826-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/12/2023] [Indexed: 02/15/2023]
Abstract
Introduction Optimal treatment of chronic distal radioulnar joint (DRUJ) arthritis and instability remains unresolved in the literature. Specifically, no systematic comparison of two common options, Sauve-Kapandji (SK) and Darrach's, is available. Methods A meta-analysis was performed utilizing the PUBMED and EMBASE databases and yielded a total of 47 available studies. Objective outcomes, such as wrist range of motion (ROM), forearm ROM, grip strength, and subjective outcomes, including pain and rate of return to work, were recorded. Statistical analysis was done using t test and chi-square test. Results For both the SK and Darrach's procedures, forearm ROM was significantly better postoperatively in both pronation (p = 0.0001 for both groups) and supination (p = 0.0001 for both groups). Wrist flexion decreased in the SK group (p = 0.0007), but no difference was found for wrist extension (p = 0.09). The Darrach's group showed a significance improvement in wrist extension (p = 0.0001). Grip strength was improved in the SK group (p < 0.0001), but not in the Darrach's group (p = 0.7831). No difference existed between the SK and Darrach's groups in proportion of patients who were pain-free. The SK group had higher numbers of patients return to work (p = 0.0057). There was not enough data from the studies to make any meaningful analysis in term of treatment failure and complications. Conclusions Overall, both the SK and Darrach's procedures helped improve pain, wrist ROM, and forearm ROM in patient with chronic DRUJ disorders. The SK procedure can have advantages over the Darrach's procedures in terms of grip strength and rate of return to work. Supplementary Information The online version contains supplementary material available at 10.1007/s43465-023-00826-5.
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Reissner L, Schweizer A, Unterfrauner I, Estermann L, Nagy L. Long-term results of Sauvé-Kapandji procedure. J Hand Surg Eur Vol 2021; 46:626-631. [PMID: 33844599 PMCID: PMC8226425 DOI: 10.1177/17531934211004459] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/23/2021] [Accepted: 03/03/2021] [Indexed: 02/03/2023]
Abstract
The Sauvé-Kapandji procedure is an established treatment option for distal radioulnar joint dysfunction. We retrospectively analysed 36 patients following Sauvé-Kapandji procedure between 1997 and 2013. Fifteen patients were available for a follow-up after a mean of 13 years (range 6 to 23). Six patients needed revision surgery because of ulnar stump instability. Radiographs and sonography were performed to quantify the instability of the proximal ulnar stump. These showed a radioulnar convergence of 8 mm without weight and 2 mm while lifting 1 kg. Sonographically, the proximal ulnar stump dislocated by 8 mm to the volar side while applying pressure to the palm, compared with 4 mm on the contralateral side. Sonographically measured ulnar stump instability showed a positive strong correlation with the Disabilities of the Arm, Shoulder and Hand questionnaire and Patient-Reported Wrist Evaluations and a negative strong correlation with grip strength and supination torque. Because of the high incidence of revision surgery due to instability of the proximal ulnar stump, we restrict the use of the Sauvé-Kapandji procedure only to very selected cases.Level of evidence: IV.
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Affiliation(s)
- Lisa Reissner
- Department of Orthopedics, Hand Surgery Division, Balgrist
University Hospital Zurich, Switzerland
| | - Andreas Schweizer
- Department of Orthopedics, Hand Surgery Division, Balgrist
University Hospital Zurich, Switzerland
| | - Ines Unterfrauner
- Department of Orthopedics, Hand Surgery Division, Balgrist
University Hospital Zurich, Switzerland
| | - Lea Estermann
- Department of Orthopedics, Hand Surgery Division, Balgrist
University Hospital Zurich, Switzerland
| | - Ladislav Nagy
- Department of Orthopedics, Hand Surgery Division, Balgrist
University Hospital Zurich, Switzerland
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Tsai TC, Chen CC, Huang HK, Wang JP. Modified Sauve-Kapandji Procedure Using Iliac Bone Graft for Giant Cell Tumor of the Distal Ulna: Stabilizing With Two-Screw Fixation: A Case Report. JBJS Case Connect 2020; 9:e0299. [PMID: 31211751 DOI: 10.2106/jbjs.cc.18.00299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We describe a 33-year-old man who had a giant cell tumor in the ulnar head treated with wide resection and reconstructed using the modified Sauve-Kapandji procedure with an iliac crest bone graft as ulnar support. CONCLUSIONS Due to the destructive nature of the tumor and the important role played by the ulnar head in the distal radioulnar joint (DRUJ), treatment of the giant cell tumor in the distal ulna is a challenge. The modified Sauve-Kapandji procedure is an effective technique to restore DRUJ function, which is performed as an ulnar support arthroplasty. Using an iliac crest bone graft as ulnar support in reconstruction surgery could be a practical method after the ulnar head has been resected.
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Affiliation(s)
- Ting-Chien Tsai
- Department of Orthopaedics, Chiayi Christian Hospital, Chiayi, Taiwan
| | - Chien-Chin Chen
- Department of Pathology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan.,Department of Cosmetic Science, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Hui-Kuang Huang
- Department of Orthopaedics, Chiayi Christian Hospital, Chiayi, Taiwan.,Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Food Nutrition, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Jung-Pan Wang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Liu S, Sun L, Chai Y, Fan C, Xu Y. [Clinical application progress of the Sauvé-Kapandji procedure]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:1131-1134. [PMID: 29798574 DOI: 10.7507/1002-1892.201702087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To review the clinical application progress of the Sauvé-Kapandji procedure. Methods The indications, techniques, effectiveness, and modifications of the Sauvé-Kapandji procedure were analyzed and evaluated by an extensive review of the relevant literature. Results The Sauvé-Kapandji procedure can be applied for various disorders of the distal radioulnar joint. Risk of series of complications exist, which might be reduced by modification of the procedure. Conclusion The Sauvé-Kapandji procedure, as a salvage operation, can be a good alternative by meticulous manipulation for appropriate cases with distal radioulnar joint disorders.
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Affiliation(s)
- Shenghe Liu
- Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai, 200233, P.R.China
| | - Luyuan Sun
- Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai, 200233, P.R.China
| | - Yimin Chai
- Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai, 200233, P.R.China
| | - Cunyi Fan
- Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai, 200233, P.R.China
| | - Yaozeng Xu
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215006,
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Ikeda M, Kawabata A, Suzuki K, Toyama M, Egi T. Outcome of the Sauvé-Kapandji procedure for distal radioulnar joint disorder with rheumatoid arthritis or osteoarthritis: Results of one-year follow-up. Mod Rheumatol 2017; 28:490-494. [PMID: 28836879 DOI: 10.1080/14397595.2017.1366005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES We performed the Sauvé-Kapandji procedure for treating disorders of the distal radioulnar joint (DRUJ) in patients with rheumatoid arthritis (RA) or osteoarthritis (OA). This study aimed to compare and clarify the results of the SK procedure between RA and OA patients. We report the one-year follow-up results of patients who underwent the SK procedure to correct the DRUJ disorder caused by RA or OA. METHODS The study included 22 wrists of 19 patients with RA and 10 wrists of nine patients with OA. Pain, grip strength and range of motion of the wrist were examined clinically. For the evaluation of the stability of the carpus, ulnar stump and bone union, parameters were measured using radiographs. Shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH) was used for functional evaluation. RESULTS Wrist pain reduced in all cases, and bone union was achieved in all wrists. The QuickDASH score significantly improved in both patients with RA and OA. In patients with RA, the range of motion increased significantly with regard to supination but decreased significantly with regard to palmar flexion. Carpal alignment and ulnar stump stability were maintained well at one-year follow-up. CONCLUSION The Sauvé-Kapandji procedure for treating disorders of the distal radioulnar joint DRUJ showed good results clinically and radiographically, irrespective of RA or OA.
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Affiliation(s)
- Mikinori Ikeda
- a Department of Orthopaedic Surgery , Higashisumiyoshi Morimoto Hospital , Osaka , Japan
| | - Akira Kawabata
- b Department of Orthopaedic Surgery , Yodogawa Christian Hospital , Osaka , Japan
| | - Keisuke Suzuki
- c Division of Hand Surgery, Department of Orthopaedic Surgery , Osaka Rosai Hospital , Osaka , Japan
| | - Masahiko Toyama
- c Division of Hand Surgery, Department of Orthopaedic Surgery , Osaka Rosai Hospital , Osaka , Japan
| | - Takeshi Egi
- d Division of Hand Surgery, Department of Orthopaedic Surgery , Osaka Saiseikai Nakatsu Hospital , Osaka , Japan
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Raven EEJ, van den Bekerom MPJ, Beumer A, van Dijk CN. Radiocarpal and Midcarpal Instability in Rheumatoid Patients: A Systematic Review. Open Orthop J 2015; 9:246-54. [PMID: 26448803 PMCID: PMC4591907 DOI: 10.2174/1874325001509010246] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 04/26/2015] [Accepted: 05/18/2015] [Indexed: 11/22/2022] Open
Abstract
Background: This study was aimed at identifying the criteria for the diagnosis of Radiocarpal instability in
rheumatoid arthritis RA). Methods: The main databases were searched to identify studies describing the pathophysiology of Radiocarpal instability
in patients with RA. We focussed on the epidemiology, radiographic parameters, criteria for instability and on treatment
options. Results. In the search 108 articles were found, of these 12 studies were included for this review. Instability occurs
in at an average of 35.2% of the rheumatoid wrists. The instability was found between 8 and 13 years after onset of
rheumatoid arthritis. A strong correlation was found between instability, duration of RA and Larsen score. Several
radiographic methods were described to evaluate Radiocarpal instability in RA. Several treatment options for instability in
patients with RA are described. All with their own indications and limitations. Conclusion: On a standard AP radiograph deformity can be measured using the carpal height and the ulnar translation
index of Chamay. This gives an indication for instability. For describing the deterioration of the joints the Larsen score is
most used. If there are more radiographs in time the Simmen classification can be used. For real assessment of instability
dynamic radiographs are needed. Level of Evidence: Level IV.
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Affiliation(s)
- Eric E J Raven
- Department of Orthopaedic Surgery and Traumatology of the Gelre Hospitals, Postbus 9014, 7300 DS Apeldoorn, The Netherlands
| | - Michel P J van den Bekerom
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Postbus 95500, 1090 HM Amsterdam, The Netherlands
| | - Annechien Beumer
- Department of Orthopaedic Surgery, Amphia Hospital, Postbus 90157, 4800 RL Breda, The Netherlands
| | - C Niek van Dijk
- Department of Orthopaedic Surgery, Academic Medical Center, Postbus 22660, 1100 DD Amsterdam, The Netherlands
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Kollitz KM, Iorio ML, Huang JI. Assessment and Treatment of Extensor Carpi Ulnaris Tendon Pathology: A Critical Analysis Review. JBJS Rev 2015; 3:01874474-201506000-00003. [PMID: 27490014 DOI: 10.2106/jbjs.rvw.n.00070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kathleen M Kollitz
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 4245 Roosevelt Way N.E., Box 354740, Seattle, WA 98105
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Affiliation(s)
- C Fontaine
- Service de chirurgie de la main et du membre supérieur, pôle des neurosciences et de l'appareil locomoteur, hôpital Roger-Salengro, CHRU, rue du Pr-Émile-Laine, 59037 Lille cedex, France.
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Kawabata A, Egi T, Tsuboi H, Takeuchi E, Fujita S, Masada K, Shi K. Modified Sauvé-Kapandji procedure for rheumatoid wrists: a long-term study with a minimum follow-up of 5 years. Mod Rheumatol 2013; 24:426-9. [PMID: 24252031 DOI: 10.3109/14397595.2013.843742] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES We performed a modified Sauvé-Kapandji procedure for treating disorders of distal radioulnar joint in patients with rheumatoid arthritis (RA). This procedure involves resecting the distal part of the ulna, rotating the resected portion by 90° and fixating it with the distal part of the radius for shelf plasty. The purpose of this study was to examine the clinical and radiographic outcomes of this procedure with more than 5 years' follow-up. METHODS We studied 32 wrists of 27 RA patients with the mean follow-up of 93.1 months after operation. Pain, grip strength and range of motion of the wrist were examined clinically, while two indices for evaluation of ulnar and palmar translation of the carpus, carpal translation index and palmar carpal subluxation ratio were calculated on radiographs. RESULTS The wrist pain reduced in all cases. Range of motion increased significantly regarding pronation and supination but decreased significantly regarding flexion. Change in grip power was not significant. No significant differences were recognized between radiographic indices, suggesting carpal alignment was maintained well throughout the follow-up period. CONCLUSIONS We think this procedure could be applied for distal radioulnar joint disorders in RA patients with promising clinical as well as radiographic outcomes over a long period.
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Affiliation(s)
- Akira Kawabata
- Department of Orthopaedic Surgery, Higashi-Sumiyoshi Morimoto Hospital , Higashi sumiyoshi-ku, Osaka , Japan
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