Procedure 84 Sauve-Kapandji Arthrodesis for Distal Radioulnar Joint Arthritis
See Video 63: Shelf Arthroplasty for Rheumatoid DRUJ Arthritis
Indications
Arthritis of the distal radioulnar (DRU) joint in young (<45 years of age) active patients with stable radiocarpal ligaments. This procedure maintains the ulnocarpal buttress and retains the triangular fibrocartilage complex (TFCC) to provide a more physiologic pattern of force transmission from the hand to the forearm and offers improved strength and function.
Malunited distal radius fractures with DRU joint arthritis.
Early presentation of rheumatoid arthritis with intact wrist ligaments.
Chronic DRU joint instability without arthritis.
Examination/Imaging
Clinical Examination
Differentiating DRU joint arthritis and ulnocarpal impaction syndrome is important in treating degenerative conditions of the ulnar wrist. Both can present with pain and swelling, decreased grip strength, and stiffness. Moreover, both may coexist and require treatment to relieve symptoms. This distinction should be made in order to proceed with the appropriate surgery.
Visible subluxation of the DRU joint indicating instability due to ligamentous laxity or injury.
Marked tenderness with stressing of the DRU joint.
Imaging
Posteroanterior, oblique, and lateral radiographs of the wrist are useful to identify signs of degenerative arthritis. Findings include joint space narrowing, volar subluxation of the radius, and osteophyte formation along the proximal margin of the ulnar head, typically sparing the sigmoid notch (Fig. 84-1A and B).
Surgical Anatomy
DRU joint fit can be affected by changes in the position of the sigmoid notch. A common cause of poor fit of the DRU joint is injuries affecting the length of the radius relative to the ulna. Although the shape of this joint and the relative bone length are variable, joint congruency is required for normal function. Clear changes in congruency are usually evident on plain radiographs, but CT or MRI can give better anatomic definition of the bone and joint shape, in addition to the TFCC attachment to the ulnar head fovea.
Exposures
A dorsal midline incision with a zigzag at the wrist is used for wide exposure to the level of the extensor retinaculum (Fig. 84-2A and B).
Approach the ulna between the extensor digiti minimi (EDM) and ECU and incise the periosteum to raise radial and ulnar periosteal flaps for later closure (Fig. 84-3).
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