Wrist

Approaches

 

Volar

Dorsal

 

Volar Approach

 

Indications 

- decompression of median nerve

- synovectomy of the flexor tendons of wrist

- ORIF distal radial fractures

 

Technique

 

Incision 

- curve incision around thenar eminence from the midpalm (ulnar to thenar crease)

- to flexion crease of wrist (don't cross at 90⁰)

- then along FCR

 

Superficial dissection

- dissect through fat

- avoid the palmar cutaneous branch of the median Nnerve

- incise fascia over FCR

- mobilse FCR ulna side

- reflect pronator quadratus from radial side

- expose distal radius

 

Dorsal Approach

 

Indications 

- synovectomy 

- repair of extensor tendons in rheumatoid 

- wrist fusion 

- SL repair

- dorsal wrist ORIF

- proximal row carpectomy 

- tumour biopsy

 

Technique

 

Incision

- 8 cm long and longitudinal crossing the wrist joint midway between the radial and ulnar styloids 

- 3 cm proximal to wrist joint and 5 cm distal to it 

 

Superficial dissection

- protect branches SRN

- expose the extensor retinaculum 

- incise retinaculum over the EDC and EIP tendons in 4th wrist compartment 

- reflect EPL to radial side

- reflect EDC to ulna side

- expose the underlying distal radius 

 

Capsulotomy

- longitudinal capsulotomy 

- ligament sparing / radially based between DRC and DIC ligaments