Name of the Procedure:

Arthrodesis, distal radioulnar joint with segmental resection of ulna, with or without bone graft (eg, Sauve-Kapandji procedure).

Summary

This procedure involves fusing the distal radioulnar joint (the joint between the two bones in the forearm near the wrist) and removing a portion of the ulna bone. It may involve using a bone graft to promote healing and stability. This is commonly referred to as the Sauve-Kapandji procedure.

Purpose

Arthrodesis of the distal radioulnar joint is performed to relieve pain and stabilize the joint. It is often used to address issues like arthritis, instability, or malalignment of the wrist due to injury or degenerative conditions.

Indications

The procedure is indicated for patients experiencing:

• Chronic wrist pain unresponsive to conservative treatments
• Instability or malalignment of the distal radioulnar joint
• Arthritis affecting the distal radioulnar joint
• Previous unsuccessful surgical treatments for wrist problems

Preparation

• Fasting for at least 8 hours before the surgery.
• Adjusting or discontinuing certain medications as advised by the physician.
• Preoperative imaging studies, such as X-rays or CT scans, to assess the condition.
• Preoperative blood tests and health assessments.

Procedure Description

1. The patient is given general anesthesia or regional anesthesia.
2. An incision is made over the affected area of the wrist.
3. The distal radioulnar joint is exposed.
4. The joint surfaces are fused, and a segment of the ulna bone is resected.
5. A bone graft may be placed to promote fusion and stability.
6. The surgical site is then closed with sutures or staples, and a dressing is applied.

Duration

The procedure typically takes about 1.5 to 3 hours, depending on the complexity.

Setting

The procedure is usually performed in a hospital or an outpatient surgical center.

Personnel

• Orthopedic or hand surgeon
• Surgical nurses
• Anesthesiologist
• Surgical technologist

Risks and Complications

• Infection
• Bleeding
• Nerve or blood vessel damage
• Nonunion or delayed union of the bone graft
• Persistent pain or stiffness
• Hardware complications (if screws or plates are used)

Benefits

• Reduced pain in the wrist
• Improved stability of the distal radioulnar joint
• Improved hand and forearm function
• Enhanced quality of life

Recovery

• Immobilization of the wrist with a splint or cast for several weeks.
• Gradual rehabilitation and physical therapy to restore movement and strength.
• Follow-up appointments to monitor healing and progress.
• Full recovery may take several months, with activity restrictions during this period.

Alternatives

• Non-surgical treatments such as physical therapy, medications, or corticosteroid injections.
• Other surgical options like distal ulnar resection or prosthetic joint replacement.
• Pros and cons of alternatives depend on the specific condition and patient health status.

Patient Experience

• Patients might feel discomfort and swelling after the procedure.
• Pain can be managed with prescribed medications.
• Physical therapy will be essential for regaining movement and function.
• Gradual improvement in symptoms and function will be noticed as the wrist heals.