2015 Volume 28 Issue 3 Pages 140-145
We report a case of rheumatoid arthritis (RA) with radioulnar impingement that developed with radial head excision after the Sauvé-Kapandji (SK) procedure, and was treated with distal radioulnar joint reconstruction by using a vascularized free bone graft. A 48-year-old woman underwent the SK procedure for RA of the left wrist at another hospital at age 33. Five years later, aggravated arthritis of the ipsilateral elbow was noted, and synovectomy and radial head excision were performed. However, she experienced wrist clicking with pronation and supination of the operated forearm, and prolonged impairment of activities of daily living (ADL). Ulnar head reconstruction with a free vascularized fibular graft and syndesmoplasty of the annular ligament by using the palmaris longus tendon were performed. Bone fusion was achieved three months after the surgery, and the angles of pronation and supination were 55 and 80 degrees, respectively. The wrist clicking with pronation and supination noted before the surgery disappeared, and ADL showed improvement. At present, 18 months after the surgery, no recurrence of the symptoms or progression of degeneration of the reconstructed distal radioulnar joint has been observed on radiography.
