Sauvé-Kapandji Procedure

⚙️What This Procedure Involves

An incision is made on the ulnar side of the wrist. The DRUJ is fused using a screw — the distal ulna is permanently joined to the radius. A segment of ulna shaft (approximately 1 cm) is removed proximal to the fusion site, creating a gap that allows the radius and proximal ulna to rotate around each other. A soft tissue interposition (such as pronator quadratus or extensor carpi ulnaris) may be placed in the gap to prevent the bone ends from reuniting. The operation takes one to one and a half hours.

💡Why It May Be Recommended

The Sauvé-Kapandji procedure is recommended for painful DRUJ arthritis (post-traumatic or inflammatory) in younger, more active patients where the Darrach procedure (simple ulna head excision) carries a higher risk of instability. It preserves the ulnar head as a buttress for the carpus.

⚖️Non-Operative Alternatives

Splinting, injection, activity modification. Darrach procedure, ulnar head replacement, or wrist arthrodesis are surgical alternatives.

📋Preparing for Surgery

X-rays. Assessment of forearm rotation and DRUJ pathology.

✅Expected Benefits

Pain relief from DRUJ fusion, preservation of forearm rotation through the pseudarthrosis, and preservation of the ulnar head as a carpal buttress. Good outcomes in approximately 80–85% of patients.

⚠️Common Risks

• Proximal stump instabilityCommon

  The proximal ulna stump may be unstable and clunk during rotation.

• Reduced grip strengthCommon

  Some reduction in grip.

• ClickingCommon

  Clicking at the pseudarthrosis site.

🔴Less Common but Serious Risks

• Stump convergenceUncommon

  The pseudarthrosis gap may narrow or close, limiting rotation.

• Non-union of the DRUJ fusionUncommon

  The fusion may fail.

• Ulnar nerve irritationUncommon

  From the surgical approach.

• InfectionRare

  Wound infection.

💉Anaesthetic Considerations

Regional or general anaesthesia.

🏃Recovery and Rehabilitation

Splint for four to six weeks. Active forearm rotation exercises from four to six weeks. Grip strengthening from six to eight weeks. Full recovery three to six months.

📅Follow-Up

X-rays at six weeks and three months.

❓Frequently Asked Questions