Original and Modified Sauvé-Kapandji Procedures: A Two-Axis Framework for Surgical Decision-Making-A Narrative Review

The Sauvé-Kapandji (SK) procedure is a salvage operation that fuses the distal radioulnar joint (DRUJ) and creates an intentional pseudarthrosis in the proximal ulna, thereby relieving pain while preserving forearm rotation and ulnar-sided bony support. This narrative review (1) traces the historical evolution of the original and modified SK procedures, (2) organizes the modifications within a two-axis framework-distal bone handling and proximal soft-tissue stabilization-to clarify their indications and outcomes, and (3) proposes an indication-based decision framework keyed to bone quality and etiology, together with a research agenda to validate it. Along the bony axis, the technique differentiates stepwise according to bone quality-traditional SK, the fragment-interposition (Nakamura) type, and the ulnar-head rotation (Fujita) type; along the soft-tissue axis, the amount and position of ulnar resection appear to be the more fundamental determinants of stump stability. SK and the Darrach procedure are broadly equivalent in major outcomes, but SK may be advantageous in patients at risk of ulnar carpal translation or with high functional demand. Given that the evidence is predominantly Level IV, this two-axis framework is offered not as an established guideline but as a hypothesis-generating conceptual framework requiring validation by future comparative research. As a narrative review, this work was not designed as a systematic review or meta-analysis and does not include a registered protocol, formal quality appraisal, or quantitative data pooling.