gms | German Medical Science

Objectives/Interrogation: The Sauvé-Kapandji procedure is useful for treatment of pathological conditions of DRUJ. The purpose of this study was to describe a novel technique of arthroscopically assisted Sauvé-Kapandji procedure. This procedure is many advantages compare with conventional Sauvé-Kapandji procedure.

Methods: The criteria for this procedure for DRUJ disorders were osteoarthritis, chronic instabilities of DRUJ except Rheumatoid arthritis with chronic pain, stiffness, and disability. Arthroscopies of the radiocarpal, midcarpal joint and DRUJ are performed. Make a longitudinal incision along ulnar border of distal ulnar. Exposed the distal ulnar in the interval between the extensor carpi ulnaris and flexor carpi ulnaris tendons. Resect a segment ulnar shaft, which leaves 15mm of ulnar styloid distal and removal of a 10-15mm cuff of ulnar shaft to create an ulnar neutral variance. The ulnar articulation with the sigmoid notch of the radius and articular surface of ulnar head are shaved off cartilage and expose the subchondral bone. If TFCC preserved, we perform using DRUJ approach not to excise from TFCC. After a through debridement of the DRUJ, a bone graft can be placed at the arthrodesis site arthroscopically. The cancellous bone graft can be harvested easily from the segment of ulnar shaft that we resected. The DRUJ is fixed using Kirschner wire (K wire) and cannulated screw. Finally, pronator quadratus interpose in the gap in the ulnar shaft to prevent reossification. Five patients treated with arthroscopically assisted Sauvé-Kapandji procedure reviewed retrospectively. We evaluated functional and radiological outcome. The parameters evaluated modified Inoue's clinical evaluation score included pain (wrist, ulnar stump), range of motion (pronation, supination), grip strength.

Results and Conclusions: Five patients (3 women, 2 men) who sustained DRUJ disorder were treated with a mean age of 60 years. At an average follow-up period 13.4 months, the functional results according to the criteria of modified Inoue's clinical evaluation score were excellent in 4 cases, good in 1 case. In all patients, bone union was obtained.

Wrist arthroscopy has been recognized as one of the most effective diagnostic modalities for ulnar wrist pain. The advantages of this technique are exact diagnosis of ulnar wrist pain, its less invasive, preservation of soft tissues, faster rehabilitation, and a better cosmesis.