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Darrach vs. Sauve-Kapandji: A Comprehensive Meta-Analysis of Surgical Outcomes in Distal Radioulnar Joint (DRUJ) Dysfunction
Nguyen, MH; Samade, R; Lipari NS; Jain SA
OSU Wexner Medical Center
2021-02-15
Presenter: Minh Nguyen
Affidavit:
Greg Pearson
Director Name: Greg Pearson
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Hand
Introduction: Optimal treatment of chronic distal radioulnar joint (DRUJ) arthritis and instability remains unresolved in the literature. Specifically, no systematic comparison of two common options, Sauve-Kapandji (SK) and Darrach, is available.
Material and Methods: A meta-analysis was performed utilizing the MEDLINE and EMBASE databases and yielded 21 studies. Objective outcomes, such as wrist range of motion (ROM), forearm ROM, grip strength, and subjective outcomes, including pain and rate of return to work, were recorded. Statistical analysis was done using t-test and chi-square test.
Results: For both the SK and Darrach procedures, forearm ROM was significantly better postoperatively in both pronation (p=0.0001 for both groups) and supination (p=0.0001 for both groups). Wrist flexion differed in the SK group (p=0.0116), but no difference was found for wrist extension (p=0.0769). The Darrach group showed a significance difference in wrist flexion (p=0.0001) and extension (p=0.0001). Grip strength was improved in the SK group (p<0.0001), but not in the Darrach group (p=0.7831). No difference existed between the SK and Darrach groups in proportion of patients who were pain-free. The SK group had higher numbers of patients return to work (p=0.0057).
Conclusions: Overall, both the SK and Darrach procedures helped improve pain, wrist ROM, and forearm ROM in patient with chronic DRUJ disorders. The SK procedure can have advantages over the Darrach procedure in term of grip strength and rate of return to work.
