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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