Sauve Kapandji Procedure

Sauve Kapandji procedure is a procedure which  involves removal of about 10 mm of ulna proximal to distal radio ulnar joint and fixing the distal fragment of ulna to radius by means of screw. Sauve Kapandji procedure aims at creating a new joint at the level where ulna is cut and serves two purposes. First , the procedure unloads the ulnar bone so that there is more force is transmitted to the radius instead of the triangular fibrocartilage. Secondly,  Sauve Kapandji procedure at the same time provides a distal stabilization.

The image below illustrates the point well.

 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.
•  Ulnar neck and proximal aspect of ulnar head are exposed after dissection of the overlying tissue.
•  A kwire is put from ulna to radius  in transverse direction for the purpose of fixing ulnar head  to radius .
• Using saw , ulna is cut just proximal to the flare of the ulnar head and  a second cut is made 15 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 radiounlar joint articular cartilage is removed
• Ulnar head  held is applied to the radius with  a 4.0mm cancellous screws after drilling and tapping.
• Pronator quadratus muscle  is mobilized into the defect so created and anchored to the dorsal side of the ulnar stump.

Complications

• Distal ulnar instability can occur
• Reactive bone can form. This can result in limitation of the motion of the wrist
• Radio-ulnar impingement can occur

Image Credit: jbjs.org/data/Journals/JBJS/775/JBJA0801217580L01.jpeg