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Duke Orthopaedics
presents
Wheeless' Textbook of Orthopaedics

Dorsal Approach to the Wrist


- See Compartments: I, II, III, IV, V, VI and approach to the distal radius;

- Technique:
    - straight dorsal incision centered over the wrist;
          - because the skin is loose over the dorsum of the wrist, contractures are uncommon;
    - incise skin and subcutaneous tissue down to the retinaculum;
          - careful to preserve dorsal veins and nerves;
    - full thickness flaps are raised both medially and laterally;
    - extensor retinculum is identified:
         - retinaculum runs from the anterolateral aspect of the radius to the pisiform and the triquetrum;
         - depending on the procedure the extensor retinaculum can be "step cut" or can incised thru the second or 6th compartment;
         - in either case, the extensor retinaculum can be passed underneath the tendons (as may be needed  to cover hardware) w/ little or no postoperative bowstringing;
                - bowstringing is not a problem since wrist extension tends to occur w/ finger flexion, and therefore the axis remains near the carpi;
    - posterior interosseous nerve is identified just proximal to Lister's tubercle;
                - nerve can be cauterized for denervation;
    - wrist joint can be entered thru a anatomically based ligament spliting incision effecting a radial-based "V" flap: (ligaments of the wrist)
                - proximally  incision splits dorsal radiotriquetral ligament (proceding in an ulnar-distal direction);
                - distally the incision splits the dorsal intercarpal ligament (proceding in a direct radial direction);
                - radially based capsular flap is elevated, exposing the carpi


A Method of Defining Palpable Landmarks for the Ligament-Splitting Dorsal Wrist Capsulotomy




Original Text by Clifford R. Wheeless, III, MD.

Last updated by Clifford R. Wheeless, III, MD on Sunday, March 24, 2013 4:27 pm