Salvage of a Failed Sauvé-Kapandji Procedure

The Sauvé-Kapandji procedure has been advocated for the treatment of pain arising in the distal radioulnar joint (DRUJ). It combines an arthrodesis of the DRUJ with a short segment, distal pseudarthrosis in the ulna, just proximal to the joint fusion [1]. Although it can give good pain relief and preserve forearm rotation, it can be complicated by painful instability of the proximal ulna [2, 3]. This problem may cause significant disability and has no easy solution [4]. The site of the ulnar pseudarthrosis is important, as it has been shown that more proximal positions (>35 mm above the arthrodesis) increase the risk of pain and are associated with a lower Mayo modified wrist score [5]. This case illustrates the use of distraction lengthening of the proximal ulnar stump with a circular frame, combined with refixation of a failed arthrodesis in the management of this difficult complication.