The Kapandji-Sauvé operation. Its techniques and indications in non rheumatoid diseases.
The Kapandji-Sauvé operation consists in the arthrodesis of the distal radioulnar joint surmounted with a segmentary resection of the lower ulna. This technique may be used not only in rheumatoid dislocations of the distal radioulnar joint instead of the resection of the distal end of the ulna (Moore-Darrach) but also in traumatic diseases such as dislocations, sprains, chronical instabilities of this joint and stiffness secondary to Colles fractures. Two techniques are described, following the original one proposed in 1936. The first one (Technique I) indicated to chronical instabilities secondary to sprains and distal radioulnar dislocations. In this case, the ulnar head is in right situation at the sigmoid notch level and may be blocked at this place with two screws in mid position of prono-supination. The gap between the two extremities of the ulna must be filled by the pronator quadratus to avoid bony reconstruction. The second one (Technique II) is especially designed for the limitations of the prono-supination motion after Colles fractures, with shortening of the radius which causes an incongruency of the distal radioulnar joint and a positive ulnar variance. In this case it is necessary to lift up the ulnar head before blocking it in the sigmoid notch. A proceeding doing this automatically is described. Technique I was used in three cases and Technique II in four. In all cases the range of the prono-supination motion was normal in three to six weeks. The pains disappeared except a slight one when holding a load in supination position and when resting the hand unsteadily. The stability of the wrist was recovered allowing to unwind screw caps and to turn door knobs.