Do patients really do better after the Sauve-Kapandji procedure when compared to the Darrach procedure? A systematic review.

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Journal of Hand Surgery (European Volume)
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The online version of this article can be found at:

DOI: 10.1177/1753193411414630
2011 36: 615 originally published online 1 July 2011 J Hand Surg Eur Vol
Dariush Nikkhah, Jeremy Rodrigues and Lodewikus DeJager
procedure? A systematic review
Kapandji procedure when compared to the Darrach
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Do patients really do better after the Sauvé


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Do patients really do better after the Sauve ´–
Kapandji procedure when compared to the Darrach
procedure? A systematic review
Dear Sir,
Many surgeons consider the Sauve ´–Kapandji (S-K)
procedure to be better than the Darrach procedure
for treating dysfunction of the distal radioulnar joint
(DRUJ), with painful proximal ulna stump instability,
ulnar carpal shift (UCS) and complaints about
appearance being cited as complications of the
Darrach procedure. We believe that this belief is
not supported by published papers.
We present a systematic review of studies com-
paring theprocedures
OvidMEDLINE and EMBASE were searched for the
terms ‘Darrach’ or ‘Sauve ´–Kapandji’. All articles in
English with an abstract available were identified.
Abstracts were screened to select those describing
studies comparing the Darrach and S-K procedures.
Out of 214 abstracts found, only five comparative
studies were identified. All were retrospective. Three
described treatment of rheumatoid arthritis (RA), one
osteoarthritis (OA) and one treatment after fractures
of the distal radius. Kobayashi et al. (2005) consid-
ered only radiological outcomes; all the others con-
sidered clinical and radiological outcomes. The S-K
and Darrach’s groups in the radiological study of
Kobayashi et al. both consisted of 13 wrists in ten
patients with a mean follow-up of 4 years. The
authors found no statistical difference in UCS
between groups.
Only one article compared the S-K procedure to
the Darrach procedure after fractures of the distal
radius in patients less than 50 years old (George
et al., 2004). The study demonstrated no significant
difference in grip strength or UCS.
Two of the RA studies suggested that UCS was
more common after Darrach’s procedure, though
no statistical analyses were done to confirm this find-
ing (Hagino et al., 1999; Nakagawa et al., 2003).
Hagino et al. did note that their Darrach group was
small (n=7) in comparison to the S-K group (n=20);
bias may have arisen from this limited and infrequent
surgical experience.
Minami et al. (2005) assessed 61 wrists in 61
patients with OA of the DRUJ treated either by the
S-K procedure, Darrach’s procedure or hemiresec-
tion interposition arthroplasty. After an average
follow-up of 10 years the authors found Darrach’s
procedure to be inferior to the S-K procedure in
terms of pain relief, though this was not statistically
significant. When the data in the OA study was ana-
lysed statistically, no difference in instability between
groups was demonstrated. The authors concluded
inDRUJdysfunction.
that Darrach’s procedure is better indicated in
patients with severe OA.
There is a paucity of studies that compare out-
comes between these procedures in osteoarthritis,
rheumatoid arthritis or after fractures of the distal
radius. The evidence is limited to retrospective,
non-randomized trials with small sample sizes.
Given the increased technical difficulty and invasive-
ness of the S-K procedure and the results of our
systematic review, is it time for a multicentre pro-
spective study in the UK to determine the role for
each operation?
Conflict of interests
None declared.
References
George MS, Kiefhaber TR, Stern PJ. The Sauve ´–Kapandji
procedure and the Darrach procedure for distal radio-
ulnar joint dysfunction after Colles’ fracture. J Hand
Surg Br. 2004, 29: 608–13.
Hagino H, Ryota T, Shingo N et al. Comparative study on
Sauve ´–Kapandji and Darrach procedures in synovectomy
for rheumatoid wrists. Jap J Rheumatol. 1999, 9: 365–72.
Kobayashi A, Futami T, Tadano I et al. Radiographic com-
parative evaluation of the Sauve ´–Kapandji procedure
and the Darrach procedure for rheumatoid wrist recon-
struction. Mod Rheumatol. 2005, 15: 187–90.
Minami A, Iwasaki N, Ishikawa J et al. The treatments of
osteoarthritis of the distal radioulnar joint; long term
results of three procedures. Hand Surg. 2005, 10: 243–8.
Nakagawa N, Abe S, Kimura H et al. Comparison of Sauve ´–
Kapandji procedure and the Darrach procedure for the
treatment of rheumatoid wrists. Mod Rhematol. 2003,
13: 239–42.
Dariush Nikkhah, Jeremy Rodrigues and
Lodewikus DeJager
Bradford Royal Infirmary, Bradford, UK
Email: dariushnikkhah@hotmail.com
! The Author(s) 2011
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Two millimetre biopsy punch: A painless and
practical instrument for evacuation of subungual
haematomas in adults and children
Dear Sir,
A common method for the evacuation of subun-
gual haematoma is trephination of the nail plate to
Short report letters615
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