Sauvé-Kapandji as a Symptom-Directed Salvage Procedure in a Malunited Distal Radius Fracture: A Case Report

Malunion after distal forearm fractures, in addition to causing deformity, can produce distal radioulnar joint (DRUJ) dysfunction, secondary arthritis of both the radiocarpal and the DRUJ, and functional limitation.Identifying the predominant symptomatic pathology is important when considering a corrective osteotomy or joint-specific salvage.We report the case of a 63-year-old man who presented six months after cast treatment of distal radius and ulna fractures with persistent ulnar-sided wrist pain, difficulty gripping and lifting, and painful forearm rotation.Examination demonstrated focal DRUJ tenderness and marked pain during DRUJ ballottement testing, without focal radiocarpal tenderness.Radiographs showed distal radius malunion with associated distal ulna non-union, subtle DRUJ osteophytes, and no clear radiocarpal articular step-off.Based on clinical-radiographic correlation, the DRUJ was considered the predominant pain generator, and a Sauvé-Kapandji procedure was performed.At six weeks, the Visual Analogue Scale (VAS) pain score decreased from 8/10 to 3/10, and the patient could perform activities of daily living independently.At six months, the VAS score was 1/10, the recorded wrist flexion-extension arc increased from 75° preoperatively to 130° at six months, and the patient reported returning to his usual work without restrictions.Radiographs at six months demonstrated DRUJ fusion.This case illustrates a symptom-directed approach to distal radius malunion with associated distal ulna nonunion and predominantly symptomatic DRUJ pathology.Pain reduction and functional recovery were observed over six months.However, the single-patient design, absence of a comparator, lack of quantitative grip strength measurement, and short follow-up limit the generalizability of the conclusions regarding comparative efficacy or long-term durability.