[Results of Kapandji-Sauvé operation after distal radius fractures]

Abstract

Incongruity of the distal radioulnar joint represents a major problem following malunited fractures of the distal radius. A useful solution is the arthrodesis of the distal radioulnar joint with distal ulnar pseudarthrosis as described by Kapandji-Sauvé. The results of this procedure are presented and the indication compared to alternative treatment options discussed. Between 1991 and 1997, 19 patients were treated with a Kapandji-Sauvé procedure, for rheumatoid arthritis in seven and for a malunited fracture of the distal radius in twelve patients. All of the patients with a malunion of the distal radius were followed up 5 to 70 months postoperatively by clinical and X-ray examination. For evaluation the protocol by Martini for malunited fractures of the distal radius was used. All but one patient agreed that the operation had been beneficial and would choose to undergo the same procedure again necessary. Mean forearm rotation improved from 99 to 166 degrees. Preoperative pain was reduced in eleven patients. Two patients were completely pain-free and seven noticed pain during heavy load only. Grip strength improved postoperatively in three patients, remained unchanged in four and was diminished in three. In two patients preoperative measurements were not available. Evaluation by the Martini protocol gave three very good, four good, four fair, and one poor result. In one patient, regeneration of the ulna across the resected segment occurred necessitating a secondary excision. This resulted in a return of forearm rotation of 140 degree and good patient satisfaction. Arthrodesis of the distal radioulnar joint with distal ulnar pseudarthrosis reliably reduces pain and improves forearm rotation after malunited fractures of the distal radius. However, it cannot influence pain originating from the radiocarpal joint. Therefore, patients with advanced radiocarpal arthrosis are not suitable for the operation. We consider the procedure to be indicated when the distal radioulnar joint is compromised by the fracture itself or by posttraumatic degenerative arthrosis or when instability or subluxation of the distal radioulnar joint occurs that cannot be corrected. We have not observed persisting problems resulting from instability of the proximal ulna.