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Use of a Headless Compressive Screw (Acutrak) for Radioulnar Joint Fusion in the Sauvé-Kapandji Procedure

Kohanzadeh, Som M.D.; Gaon, Mark M.D.; Ota, Ken D.O.; Lefrennierre, Stefanie B.S.; Kulber, David M.D.

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Plastic and Reconstructive Surgery: April 2012 - Volume 129 - Issue 4 - p 759e-761e
doi: 10.1097/PRS.0b013e318245e851
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Sir:

Figure
Figure

Distal radioulnar joint disease, stemming from trauma or degenerative arthritis, causes pain and limits hand function, especially forearm supination and pronation. The Sauvé-Kapandji procedure is a useful and popular treatment of distal radioulnar joint instability, whereby the joint is fused and a pseudoarthrosis is created proximal to this fusion.15 Frequent complications associated with hardware include chronic pain and irritation from hardware protrusion, and ulnar stump instability.15 Consequently, various modifications have been presented to address these complications.15

Use of the Acutrak (Acumed LLC, Hillsboro, Ore.) headless compression screw in the Sauvé-Kapandji procedure increases fixation strength, and the headless design eliminates hardware protrusion. This is achieved thanks to a wide-to-narrow thread pitch along the screw, which promotes fixation, and a conical shape, which increases resistance within the bone as it advances forward (Fig. 1).

Fig. 1
Fig. 1:
The standard Acutrak (Acumed LLC, Hillsboro, Ore.) headless compression screw.

Between November of 2004 and 2007, 17 patients with distal radioulnar joint disorders were treated using the Sauvé-Kapandji procedure with the Acutrak headless screw. There were seven male and 10 female patients with a mean age of 37 years; five had left wrist morbidity, 12 right-sided. There was mean follow-up of 23 months. All patients had failed nonoperative treatment. Thirteen patients had chronic distal radioulnar joint instability from trauma and four from osteoarthritis. All patients complained of wrist pain preoperatively. All patients attended hand therapy for 4 to 6 weeks.

In all 17 patients, distal radioulnar joint fusion was successful and range of motion at the wrist was markedly improved, with no incidences of hardware loosening (Fig. 2). There were no complications, such as abscess formation, loss of sensation, or major pain.

Fig. 2
Fig. 2:
Serial wrist images representing fusion results at 1 year demonstrate successful distal radioulnar joint fusion.

Various methods on improving distal radioulnar joint stability after the Sauvé-Kapandji procedure have been proposed.15 The modified procedure, as described by I. A. Kapandji, son of the original author,5 describes using two screws instead of one in the distal ulnar segment and resecting 2 cm of ulnar shaft proximal to the arthrodesis site versus 3 cm, as originally described. Further modifications include the use of two Kirschner wires instead of screws and describe resecting the ulna further distal than in the original Sauvé-Kapandji procedure, as described by Taleisnik.2 Rothwell et al. described placing a single screw across the distal radioulnar joint without exposing or decorticating the joint surfaces. This did not gain popularity, however, because of the lack of adequate compression and stability.4

The Acutrak headless screw eliminates this instability. The screw's conical shape compresses bone as it advances forward, thereby increasing joint compression and creating a stable fusion even from the immediate postoperative period (Fig. 2). This immediate stability aids in early mobilization and therapy, and eliminates the need for stabilizing wires and a second screw. Furthermore, the headless nature of the screw (Fig. 1) eliminates hardware protrusion, which has been implicated as a causative factor of chronic pain after the use of traditional hardware.24

In conclusion, use of the headless, compressive screw is optimal for distal radioulnar joint fusion in the Sauvé-Kapandji procedure because of the absence of hardware protrusion while also increasing fusion stability. This eliminates the major complications of postoperative pain, hardware infection, and distal radioulnar joint instability, while simultaneously maximizing union rates.

Som Kohanzadeh, M.D.

Mark Gaon, M.D.

Ken Ota, D.O.

Stefanie Lefrennierre, B.S.

David Kulber, M.D.

Cedars-Sinai Medical Center, Los Angeles, Calif.

DISCLOSURE

The authors have no financial interest to declare in relation to the content of this article.

REFERENCES

1. Sauvé L, Kapandji M. Nouvelle technique de traitement chirurgical des luxations recidivantes isolees de l'extremite inferieure du cubitus. J Chir (Paris). 1936;47:589–594.
2. Taleisnik J. The Sauvé-Kapandji procedure. Clin Orthop. 1992;275:110–124.
3. Sanders RA, Frederick HA, Hontas RB. The Sauvé-Kapandji procedure: A salvage operation for the distal radioulnar joint. J Hand Surg Am. 1991;16:1125–1129.
4. Rothwell AG, O'Neill L, Cragg K. Sauvé-Kapandji procedure for disorders of the distal radioulnar joint: A simplified technique. J Hand Surg Am. 1996 21:771–777.
5. Kapandji IA. The Kapandji-Sauvé operation: Its techniques and indications in non-rheumatoid disease. Ann Chirurg Main. 1986;5:181–193.

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