A Modified Extensor Carpi Ulnaris Tenodesis with the Sauvé-Kapandji Procedure

Area of Science:

• Orthopedic Surgery
• Hand and Wrist Surgery
• Reconstructive Surgery

Background:

• The Sauvé-Kapandji (S-K) procedure, introduced in 1936, has undergone modifications to address proximal ulnar stump pain.
• Dynamic stabilizers like the extensor carpi ulnaris (ECU) and flexor carpi ulnaris (FCU) have been employed in these modifications.
• This study explores a novel modification for distal ulnar stump instability.

Purpose of the Study:

• To evaluate the efficacy of a modified Sauvé-Kapandji (S-K) procedure using extensor carpi ulnaris (ECU) tenodesis.
• To assess the procedure's effectiveness in treating distal radioulnar disorders, including instability and pain.
• To determine the impact on forearm rotation, grip strength, and distal ulnar stump stability.

Main Methods:

• Thirteen patients underwent the modified S-K procedure with ECU tenodesis to the carpus and interosseous membrane between January 1998 and February 2017.
• Patient diagnoses included traumatic arthritis, primary osteoarthritis, rheumatoid arthritis, gouty arthritis, and Madelung deformity.
• Follow-up averaged 30 months, with assessments of pain, range of motion, grip strength, and radiographic stability.

Main Results:

• Significant improvement in forearm pronation and supination was observed post-surgery.
• All patients reported reduced wrist pain, with 10 experiencing complete pain relief.
• Mean grip strength increased from 51% to 75% of the contralateral side, and radiographic evaluation showed no distal ulnar stump instability.

Conclusions:

• The modified S-K procedure with ECU tenodesis provides multi-directional stability for the distal radioulnar joint.
• This technique is a reliable surgical option for managing various distal radioulnar disorders.
• The modification effectively addresses pain and improves functional outcomes, including grip strength and forearm rotation.