Purpose: The Sauvé-Kapandji procedure is often performed for the treatment of posttraumatic degeneration of the distal radioulnar joint. Few studies have been devoted specifically to the proximal stump of the ulnar after this procedure. The aim of our study was to conduct a radioclinical evaluation of the dynamics of the proximal ulnar stump.

Material and methods: This retrospective analysis involved fourteen patients (four women and ten men), mean age 48 years who underwent the procedure between January 1991 and March 2002. All presented posttraumatic degradation of the distal radioulnar joint. The operation took place twelve months after trauma on average. Mean ulnar resection was 11 mm, performed as distally as possible. The pronator quadratus was not advanced into the false joint. Pronation-supination rehabilitation exercises were instituted shortly after surgery. A static and dynamic x-rays protocol was designed for analysis.

Results: Patients were reviewed at five years two months on average. There were two complications: fusion of the intentional ulnar pseudarthrosis and one pseudarthrosis of the distal radioulnar joint. Time to resumption of former activity was nine months on average. Two patients could not resume their former activity. Seven patients complained of mechanical pain at the ulnar resection. Three patients reported cracking sounds along the ulnar border of the wrist and two patients presented an objective snap during pronosupination. Clinically, the ulnar stump was unstable in the sagittal plan in all cases. Radiographs confirmed this instability. Clinically, there was also an instability in the frontal plane in three patients. The dynamic films did not confirm frontal instability.

Discussion: Although less so than after the Darrach procedure, the proximal ulnar stump is the principle complication of the Savué-Kapandji procedure. Preservation of the structures stabilising the distal ulnar stump is crucial: periosteum, interosseous membrane, ulnar extensor of the carpus, pronator quadratus. Our use of a shorter resection made as distally as possible was only able to avoid a certain degree of instability which was nevertheless well tolerated.

Conclusion: The Sauvé-Kapandji procedure provides very satisfactory results for pain and motion. All patients appeared to have some degree of distal ulnar stump instability which was as a rule well tolerated. Nevertheless, one patient required a revision for stabilisation. This instability remains an unsolved problem which apparently cannot be prevented even with a very rigorous technique.

Purpose: Subtalar dislocation is an exceptional finding. En bloc dislocation under the talus leads to talocalcaneal talonavicular luxation, generally observed in young active adults. Prognsosis is related to the risk of infection and talar necrosis. We report a retrospective series searching for featues influencing long-term clinical outcome.

Material and methods: Between 1984 and 1990, twelve cases of subtalar dislocation were treated in our unit. There were nine lateral and three medial cases. Six lateral dislocations were open injuries, the head of the talus exposed medially. Treatment consisted in emergency orthopaedic reduction associated with debride-ment and closure in case of open injury. Temporary pinning (45 days) between the talus and the calcaneus was used in six cases. There were two lesions of the posterior tibial bundle which were repaired in the emergency setting. A supramalleolar lateral flap (Masquelet) was needed in one patient who developed cutaneous necrosis exposing the anterior tibial. Postoperative immobilisation consisted in a plaster boot for 45 days in all cases.

Results: Mean follow-up was ten years. Clinical outcome was good in eleven patients (slightly limited dorsal flexion, 10°) and fair to poor in one. We did not have any case of talar necrosis or subtalar degeneration.

Discussion: This series confirms data in the literature. Pure dislocation has as a rule a good prognosis although there is some discrepancy in the literature. In our series, lateral dislocation was more frequent than medial dislocation. Skin opening is frequent and is not a factor of poor prognosis. The absence of talar necrosis is related to preservation of the deltoid branch of the posterior tibial artery and respect of the fibular artery collaterals which supply the posteriolateral tubercle and the tarsal sinus. Emergency reduction of peritalar dislocations eliminates vascular suffering and limits the risk of infection. A temporary talocalcaneal pin is indispensable if the joint is unstable after reduction.