Kapandji-Sauv, procedure with distal radioulnar fusion and segmental resection of the ulna

The Kapandji-Sauv, procedure aims at improvement of rotation in the distal radioulnar joint and reduction of pain. Cases of ulnar impaction syndrome can also be corrected during the same procedure. The most important indication is painful und restricted forearm rotation after fracture of the distal radius combined with obsolete dislocation or destruction of the distal radioulnar joint. It is a salvage procedure and is contraindicated when reconstruction of the radioulnar joint or shortening of the ulna is possible. Further contraindications are rheumatic arthritis and osteoporosis. The Kapandji-Sauv, procedure creates a new distal rotatory joint due to distal radioulnar fusion and segmental resection of the distal ulna. Forearm cast including the wrist for 3-4 weeks. Phyisiotherapy and intensive exercises of the fingers on postoperative day 1. After removing the cast, careful rotation exercises are possible. In 75 patients, the Kapandji-Sauv, procedure was performed between 1990 and 2003. Failure was observed in one patient with a bony regeneration between the resected ulnar segment. In 3 cases, a nonunion of the radioulnar joint was found. After revision with bone grafting, bony consolidation of the joint was identified in all cases. In 2 cases, there were problems with the proximal ulnar stump, whereby this was corrected in one case by resection of a ball-type callus. In the other case, painful ulna-snapping was reduced by shortening of the ulna. In earlier follow-up with 45 patients and later long-turn follow-up, ranging from 3-12 years, not only were significant improvement of forearm rotation and reduction of pain observed, but also good patient satisfaction was found.