Objective : We first analyzed the ulnar proximal stump behavior after the Sauvé-Kapandji procedure in rheumatoid wrists added to stabilization using flexor carpi radialis and extensor carpi ulnaris. We then studied whether the forearm axis of rotaion corresponded to a line connecting the center of the radial head to the proximal ulnar stump.
Methods : The procedure was done for distal radio-ulnar joint disorders of the wrist caused by rheumatoid arthritis. We retrospectively studied 19 hands. Mean patients age at surgery was 62.8 years. We evaluated the history of rheumatoid arthritis, pain relief, swelling, grip strength, radioulnar distance, complications, and the radio-ulnar distance at the stump using computed tomography during pronation, supination, and neutral positions of the forearm in 15 of the 19 hands operated on.
Results : No patients showed any sign of pain at the proximal ulnar stump or any scallop sign. Grip strength increased significantly, as did wrist pronation, supination, and extension. Wrist flexion was not significant. The rate of complications was low. Radiographically, the radio-ulnar distance of the neutral wrist decreased from 13.5±3.0 mm in pre-operatively to 10.7±2.0 mm at the final check. No significant difference was seen in wrist supination, pronation or neutral position. In all cases, the line connecting the center of the radial head to the proximal ulnar stump served as the forearm axis of rotation as comf ormed by computed tomography.
Conclusion : Our procedure added to the Sauvé-Kapandji procedure for the wrist in the rheumatoid arthritis effectively stabilized ulnar proximal stumps.
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