- Dorsal to the scaphoid
This approach is used for the following injuries:
Proximal pole fractures
Complete scapholunate (SL) ligament rupture.
Scaphoid fractures, or complete SL ligament ruptures with concomitant distal radial fractures.
Straight skin incision
Make a straight dorsal skin incision starting over Lister’s tubercle...
...and extending for about 4 cm distally.
Identify the radial nerve
Identify and preserve the dorsal superficial branch of the radial nerve, which runs in the radial skin flap of the wound.
Note the radial nerve.
Incise the retinaculum
Incise the extensor retinaculum over the extensor pollicis longus (EPL) tendon,...
...opening the distal part of the third extensor compartment.
Retraction of the tendons
The EPL tendon is then retracted radially together with the tendons of the
second extensor compartment (extensor carpi radialis brevis and longus).
The fourth extensor compartment, containing the extensor digitorum and extensor indicis, is located on the ulnar side.
Opening the capsule
Make a longitudinal, or inverted T-shaped, incision, starting at the dorsal rim of the distal radius, extending to the dorsal intercarpal ligament.
Take care to preserve the vessels to the dorsal ridge of the scaphoid.
The capsule is not stripped from this area.
Expose the scaphoid
To expose the proximal pole of the scaphoid, it is necessary to flex the
The scaphoid now comes into view. Identify the SL ligament.
Close the capsule with interrupted sutures.
Close the third extensor compartment, avoiding any tension over the EPL tendon, which must glide smoothly. If this is not possible, the EPL tendon is best left superficial to the retinaculum, in the subcutaneous tissue.