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Sauve Kapandji Procedure


- Discussion:
    - indicated for arthritic RU Joint w/ limitation of motion;
    - may be useful for rheumatoid patients w/ ulnar translocation, as well as the caput ulna syndrome;
    - procedure involves resection of a portion of distal ulna shaft and fusion of the ulnar head to the radius;
    - maintains function of triangular fibrocaritlage complex, & maintains normal anatomic configuration of wrist
           - in addition, the ECU tendon is maintained in a relatively normal position in relation to the carpus;
    - procedure should restore forearm rotation;
    - it should not be performed when the ulnar variance is positive ulness ulna is shortened as part of the procedure;
    - in the report by Carter PB and Stuart PR (2000), the authors conducted a retrospective series of 41 Sauve-Kapandji
           procedures carried out for complications of fractures of the distal radius;
           -  indications for surgery were pain on the ulnar side of the wrist and decreased rotation of the forearm;
           - pain was improved in 25 of the 37 patients, and unchanged in ten;
           - rotation of the forearm returned to within 7° of the uninjured side;
           - The Sauve-Kapandji procedure for post-traumatic disorders of the distal radio-ulnar joint

- Technique:
    - incision is made between the ECU and EDQ, beginning 5 cm above the ulnar head and ending distal to the ulnar head;
           - care is taken to avoid cutting the dorsal ulnar sensory nerve;
    - care is taken to avoid disturbing the ECU tendon sheath, and instead the dissection proceeds thru the tendon sheath of the EDQ;
    - ulnar neck and proximal aspect of ulnar head are exposed;
    - a towel clip is applied to the ulnar head (or a K wire is driven into the ulnar head) to help with orientation and manipulation of the distal fragment;
    - osteotomy: performed just proximal to the RU joint articular cartilage, or just proximal to the flare of the ulnar head;
           - a second cut is made 15 mm proximal to the first cut and the segment of ulna is removed;
   - RU joint articular cartilage is removed;
   - ulnar head is applied to the radius and is held with pins or w/ a 4.0 cancellous screw and a pin;
   - mobilize the pronator quadratus into the defect left by the resected ulnar shaft to prevent bone bridging;
           - pronator is achored by drill holes made in the dorsal side of the ulnar stump;
   - dorsal capsule should be repaired;

- Contra-indications:
    - unstable RU joint or RU joint dislocation;

- Complications:
    - distal ulnar instability:
          - if excessive bone is resected, distal portion of proximal ulna may be unstable;
          - this complication is more likely to occur if instability existed preoperatively;
          - a non painful clunk will be present in more than 50% of patients;
    - reactive bone formation:
          - if inadequate bone is resected, reactive bone may form at osteotomy site, limiting motion;
    - radio-ulnar impingement

The Sauve-Kapandji procedure.

Sauve-Kapandji procedure for disorders of the distal radioulnar joint: a simplified technique.

The Sauve-Kapandji procedure for reconstruction of the rheumatoid distal radioulnar joint.    

History and Evolution of the Sauvé-Kapandji Procedure