Radiological and clinical analysis of Madelung's deformity in children.

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Abstract

[Indexed for MEDLINE] 10. J Hand Surg Am. 2020 May;45(5):408-416. doi: 10.1016/j.jhsa.2019.11.014. Epub 2020 Jan 13. Functional Outcomes After Sauve-Kapandji Arthrodesis. Giberson-Chen CC(1), Leland HA(1), Benavent KA(2), Harper CM(1), Earp BE(2), Rozental TD(3). Author information: (1)Department of Orthopaedics, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA. (2)Department of Orthopedics, Harvard Medical School, Brigham and Women's Hospital, Boston, MA. (3)Department of Orthopaedics, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA. Electronic address: trozenta@bidmc.harvard.edu. PURPOSE: The Sauve-Kapandji procedure (SK) combines a distal radioulnar joint (DRUJ) arthrodesis with the creation of an ulnar pseudarthrosis for the salvage of DRUJ instability or arthritis. Despite several published case series, there are limited data on postoperative functional outcomes. This study evaluates patient-reported outcomes of SK using a validated functional outcomes scale. METHODS: We performed a retrospective review of patients who underwent SK in 2 health care systems over 10 years (2008-2018). Preoperative and postoperative range of motion, Quick-Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores, and wrist plain film radiographic measurements were recorded. Preoperative and postoperative outcomes analyses and subgroup comparisons were performed. RESULTS: We included 57 patients in the study. Surgical indications included posttraumatic DRUJ arthritis (n = 35), rheumatoid arthritis (n = 10), degenerative DRUJ arthritis (n = 7), Madelung deformity (n = 3), psoriatic arthritis (n = 1), and giant cell tumor of bone (n = 1). During the first postoperative year, QuickDASH scores decreased from a mean of 52 before surgery to 28 at 12 months. The QuickDASH scores at final follow-up demonstrated significant improvement in patients with osteoarthritis and inflammatory arthritis. Supination significantly improved after surgery, from 48° to 74°, whereas wrist flexion, wrist extension, and pronation remained unchanged. Radiographically, significant postoperative decreases were seen in ulnar variance and McMurtry's translation index. The postoperative complication rate was 21%, including revision osteotomy in 4 patients (7.0%) and hardware removal in 4 patients (7.0%). No DRUJ nonunions were seen. CONCLUSIONS: The Sauve-Kapandji procedure for DRUJ salvage significantly improved patient-reported outcomes after 1 year and significantly improved supination. Similar functional improvements after SK were seen in both osteoarthritis and inflammatory arthritis. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV. Copyright © 2020 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved. DOI: 10.1016/j.jhsa.2019.11.014