Salvage of the unstable Sauvé-Kapandji procedure: a new technique

The Sauvé-Kapandji procedure has been commonly performed in the setting of posttraumatic osteoarthritis of the distal radioulnar joint. A recognized complication is instability of the proximal ulnar stump, which may occur in up to 33% of cases. Salvage of the failed Sauvé-Kapandji procedure in this setting is difficult and can sometimes involve sacrifice of forearm rotation. We report the results of 3 cases of a new salvage procedure in this setting. The radioulnar pseudarthrosis was taken down; ulnar continuity was restored with an intercalary graft; and forearm rotation was restored with matched hemiresection and interposition arthroplasty at the site of previous radioulnar fusion. Postoperatively, all patients achieved good forearm rotation (mean supination, 60 degrees; mean pronation, 65 degrees), had no symptoms of instability, and were satisfied with the results of the procedure. Disabilities of the Arm, Shoulder and Hand scores improved from preoperative mean of 55 to postoperative mean of 18.