T he S auv e' - K apandji proce dure in the le s ion s of the dis t al radioulanr joint

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1 4 2 Vol. 4, No 2, Nove mbe r Sauve-Kapandji =A bs t ract = T he S auv e' - K apandji proce dure in the le s ion s of the dis t al radioulanr joint Duk e W h an Chu n g, MD., You n g S oo Ch un, MD. H aun g Gu K w on, MD., and Ch an g H ee H an, MD. Departm ent of Orthop edic S urgery, School of M edicine, K yung H ee University, Seoul, K orea Purpo s e : T o evaluate the clinical and radiographic results of the treatment for distal radio- ulnar joint abnormalities in various patient s resulting from trauma follow ing Sauve' - Kapandji procedure. M at erials and m ethods : Betw een Jan and Aug. 1998, 7 patient s, 7 wrists w ere treated for distal radioulnar joint abnom alities resulting from trauma following Sauve' - Kapandji procedure. T he average age of patients w ere 43 year s(18-65 years), three patient s w ere w omen and four w ere m en. T he average follow up period after this procedure w as 12 months (4-24 months). We analysed clinical result s according to the wrist- scoring system of Mayo clinic, radiographic results according to the ulnar variance of Palmar ' s method. Re sult s : All patient s had improved in pain. T he pronation/ supination range of motion w as changed from 36/ 34 degrees(preoperatively ) to 73/ 60 degrees (last follow up). T he flexion/ extension range of motion w as changed 19/ 38 degrees to 45/ 45 degrees. T he wrist- scoring sy stem of Mayo clinic w as average 60 point s before operation and 90 points at the last follow up. Radiologically, ulnar variance w as 8mm before operation and 1mm at the last follow up. Con clu sion : T he Sauve' - Kapandji procedure is u seful in cases of chronic dislocation of the distal radioulnar joint with destruction of the joint surface Key W ords : Distal radioulnar joint, degenerative change, positive ulnar variance, Sauve' - kapandji procedure :

2 (Darrach procedure) 16).,,,,, 1, 12, 15, 22 `,2 3 ). 10, 23). (Darrach procedure) Bower (hemirescetion), Watson matched 5-7, 11, 14).,,,, 12). Sauve' - kapandji 2,17)., 7 Sauve' - kapandji. 1.,, Sauve' - kapandji , , 1 (Dominant hand) Colles ' 6, Palmer 9). T able 1. Clinical data of the patient s Case Sex/ age Cause of Duration of Follow up Range Range pain ulnar variance wrist score injury Sx (m ) period(m ) preoperative postoperative pre/ postoperative pre/ postoperative pre/ postoperative *P/ S/ F/ E *P/ S/ F/ E 1 F/ 65 F all Dow n / 30/ 5/ 50 60/ 60/ 35/ 50 +/ - 9/ 1 58/ 90 2 F/ 59 Slip Dow n / 15/ 10/ 75 80/ 70/ 60/ 50 +/ - 7/ 0 57/ 91 3 M/ 43 Slip Dow n / 40/ 15/ 20 70/ 50/ 50/ 60 +/ - 9/ 1 55/ 87 4 M/ 50 Slip Dow n / 50/ 30/ 40 80/ 60/ 50/ 40 +/ - 10/ 2 66/ 92 5 F/ 42 Slip Dow n / 40/ 20/ 30 80/ 70/ 60/ 50 +/ - 6/ 0 64/ 95 6 M/ 26 Slip Dow n / 10/ 20/ 20 50/ 50/ 20/ 30 +/ - 7/ 1 54/ 83 7 M/ 18 Slip Dow n / 50/ 30/ 30 90/ 60/ 40/ 40 +/ - 8/ 1 64/ 94 * P/ S/ F/ E : pron ation/ su pin ation/ flex ion/ ex ten sion

3 T able 2. Modified Wrist - Scoring System ot the Mayo Clinic(JBJS 71- A,1989) Categ ory score* F indin g s (point s ) pain 25 None 20 Mild, occasion al 15 M oderat e, tolerable 0 S ev ere or int olerable F un ctional st atu s 25 Return to regular em ploym ent 20 Restru cted em ploym ent 15 Able to w ork but unem ploy ed 0 Unable t o w ork becau se of pain P ronation - supin ation 25 > 170 degrees degrees degrees degrees 0 < 60 degrees Grip strength percent (percent age of that percent on n orm al side) percent percent percent millimeter. 7 8mm (6mm - 11mm ). 4. Mayo clinic (modified to include rotation of the forearm ) wrist - scoring system 8).,,,, excellent, good, fair, 65 poor. (T able 2). 5. 1) Sauve' - Kapandji.... Ronzeur

4 15 mm inch Kirschner. (Ulnar variance) 15 mm. Lag 3.5mm AO.(Fig.1A, 1B) ,,, Sauve' - Kapandji. 5, 50, 20, (narrowing), S (sclerosis) 9mm (Fig. 2A). 18 1mm (Fig. 2B). 35, 80 60, 50, A B Fig. 1. A and B. Surgical technique. A. Segment of ulna excised. Distal radioulnar articulation exposed, about to be excised to expose subchondral cancellous bone. B. Radioulnar fixation completed by absorbable screw

5 B A C D Fig. 2. A and B. Case 1. Sixty - five years old patient with chronic painful instibility of the distal radioulnar joint. (A) preoperative anteroposterior, positive ulnar variance of 10 mm and (B) posteroanterior roentgenogram at 12 months after Sauvé- Kapandji procedure. the positive ulnar variance of 1 mm. C and 2. Photographs made at the latest follow - up evaluation, (C) showing 80 degrees of extension and (D) 35 degrees of flexion of the involved limb(right ), which was comparable with the range of motion of the contralateral limb (Fig. 2C, 2D) Colles ' 12 Sauve' - Kapandji

6 A B Fig. 3. A and 3B. Case 2. Fifty years old patient with chronic painful limitation of motion at involved distal radioulnar joint. (A ) preoperative posteroanterior and lateral roentgenogram and (B) posteroanterior and lateral roentgenogram at 6 months after Sauvé- Kapandji procedure. 30, 40, 60, (narrowing) 10mm (Fig. 3A). 6 1mm (Fig. 3B). 20, 30 50, 50, Good 0, Fair 1, Poor 6 12 Excellent 5, Good 2, Fair 0. (T able 1). 2. 8mm 1mm 12 1mm. (Darrach procedure),,, 10), 1, 4, 10, 23) (Sauve' - kapandji procedure). Milch 18) Colles '

7 cuff. Palmer 21, 22 ). Sauve' - kapandji. Richard 23) 10 1 Sauve' - kapandji, Leonad 19) 15 Sauve' - Kapandji. Nakamura 20) % ,, Sauve' -kapandji. Kent 15) 21, 86 (Ulnarward translocation) (Palmar translocation ). Alastair 2) Sauve' - kapandji , , , Lag 3.5 mm AO. Sauve' - kapandji 1, 5), 3, 12), 24), 19, 21, 22, 25). 7 Sauve' - kapandji

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