Sauve Kapandji Procedure

Last Updated on February 10, 2024

Sauve Kapandji procedure includes an arthrodesis across the distal radioulnar joint and creating a pseudarthrosis of the ulna, proximal to the fusion. This allows the distal radioulnar joint to be arthrodesis and restore pronation and supination.

Another commonly used procedure for distal radioulnar joint or distal ulna conditions is Darrach’s procedure. The Sauve-Kapandji procedure differs from the Darrach procedure in that it preserves ulnar support of the wrist, a common issue with Darrach’s procedure. It also saves the distal radioulnar and ulnocarpal ligaments.

Relevant Anatomy

The distal ulna is formed by a small rounded head and an ulnar styloid process. The head of the ulna articulates with the ulnar notch of the distal radius via the lateral convex articular surface to form the distal radioulnar joint.

There is a disc called the triangular fibrocartilage that separates the head from the wrist bones.

The ulnar styloid process projects distally from the posteromedial aspect of the distal ulna and can be palpated clinically.

The subcutaneous tissue of the dorsal ulnar wrist contains the dorsal sensory branch of the ulnar nerve.

Sauve Kapandji procedure is a procedure that involves the removal of about 10 mm of ulna proximal to the distal radioulnar joint and fixing the distal fragment of the ulna to radius by screw. This creates a gap or pseudojoint where the ulna can rotate, thus preserving pronation and supination while at the same time changing the dynamics so that the radius is loaded more while distal stabilization is not affected much.

 

 Indications of Sauve Kapandji Procedure

The procedure is contraindicated in unstable radioulnar joint or radioulnar joint dislocation.

Technique of Sauve Kapandji Procedure

• An incision is made on the medial aspect beginning 5 cm above the ulnar head and ending distal to the ulnar head. Some surgeons prefer using an inverted V incision centered over the ulnar head.
• The dorsal sensory branch of the ulnar nerve should be protected. It runs obliquely from the proximal-anterior to the distal-dorsal region.
• The capsule of the distal radioulnar joint is removed to expose the ulnar neck and proximal aspect of the ulnar head
• The joint cartilage and subchondral bone of the ulnar head are removed.
• The ulnar head is perforated using a drill  perpendicular to the long axis of the radius and ulna
• A wire is put from the ulna to the radius in a transverse direction to temporarily fix the ulnar head to the radius.
• Using a saw, the ulna is cut just proximal to the flare of the ulnar head, and a second cut is made 5 mm proximal to the first cut.
• If the saw is not available, multiple drill holes are made and then osteotomy is completed using osteotomes.
•  The ulnar segment is removed.
• The distal ulnar fragment is lifted and radioulnar joint articular cartilage is removed
• The Ulnar head is fixed to the radius with 4.0 mm cancellous screws or a malleolar screw.
• The screw is advanced into the radius so that ulnar and radial bone surfaces are compressed adequately.
• The pronator quadratus muscle is mobilized into the defect so it is created and anchored to the dorsal side of the ulnar stump.
• A plaster bandage is applied for 7 to 10 days.
• After stitch removal, the patient is instructed to carry pronation and supination exercises.

Complications

• Distal ulnar instability
• Reactive bone formation
• Decreased wrist motion
• Pseudoarthrosis
• Nonunion
• Painful instability of proximal ulna stump
• Radioulnar impingement can occur

Prognosis

The procedure results in satisfactory results in the majority of the cases.  Radiocarpal joint mobility is not affected and often, the patient achieves full pronation and supination.

The best results are obtained if the pseudoarthrosis is done at the level of the ulnar head.

References

• Lluch A. The sauvé-kapandji procedure. J Wrist Surg. 2013 Feb;2(1):33-40. [Link]