[Functional results after the Kapandji-Sauvé operation for salvage of the distal radioulnar joint].
BACKGROUND
The Kapandji-Sauvé procedure is a salvage operation for the treatment of painful arthrosis of the distal radioulnar joint (DRUJ). It should be performed if an anatomical reconstruction of the DRUJ is not longer possible. The present study was designed to evaluate mid-term results by means of objective parameters (strength, range of motion, Krimmer and Mayo wrist scores) and subjective self-assessment of patient disabilities (DASH, pain) after the Kapandji-Sauvé procedure.


METHODS
Fifteen patients (8 female, 7 male, average age 49 years) underwent Kapandji-Sauvé procedure and were retrospectively reviewed 55 months after the operation (range, 6 months to 8 years). As a reason for DRUJ arthrosis we found fractures of the distal radius in 7 patients, severe contusion and distorsion trauma (5), luxation of the DRUJ (2) and a Madelung deformity (1). For evaluation of grip strength the Jamar dynamometer was used. Pain assessment was performed with a visual analogue scale (VAS 0 - 100) pre- and postoperatively, before and after physical load was used. The DASH questionnaire was used in all patients for subjective outcome assessment.


RESULTS
Forearm rotation improved by 59,7 % (89,3 to 142,7 degrees) as well as grip strength by 63,6 % (13 to 20,7 kg) compared preoperative to postoperative. Pain reduction was significant (p = 0,003) before physical load by 48,6 % and after physical load by 63,1 % compared with the preoperative values. The mean DASH score was 41,6 points, Krimmer and Mayo-Wrist scores were 61 and 63 respectively. Radioulnar impingement occurred in 14 patients after an X-ray under load. Because of the improvement of forearm rotation and grip strength 12 patients would undergo the procedure again, three patients were not satisfied with their results.


CONCLUSIONS
Our clinical findings show good improvement of forearm rotation, grip strength and reduction of pain after Kapandji-Sauvé procedure. However midrange DASH, Mayo and Krimmer-Wrist scores suggest that the Kapandji-Sauvé procedure is not able to provide a solution for every complex, non-reconstructable DRUJ disorder.
Klinik für Hand-, Plastische und Rekonstruktive Chirurgie - Schwerbrandverletztenzentrum, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Plastische und Handchirurgie der Universität Heidelberg, Germany. cczermak@bgu-ludwigshafen.de
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Czermak
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Wittemann
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Germann
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Sauerbier
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001174:Arthrodesis / Q000379:methods*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength / Q000502:physiology*; D006801:Humans; D004204:Joint Dislocations / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology*; D010003:Osteoarthritis / Q000000981:diagnostic imaging / Q000601:surgery*; D010043:Outcome and Process Assessment, Health Care; D010147:Pain Measurement; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011859:Radiography; D011885:Radius Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D016059:Range of Motion, Articular / Q000502:physiology*; D012189:Retrospective Studies; D014954:Wrist Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*