Executive Editor: Chris Colton

Authors: Matej Kastelec, Renato Fricker, Fiesky Nuñez, Terry Axelrod

Carpus

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Glossary

Dorsal to the scaphoid
Proximal pole fractures enlarge

Indications

This approach is used for the following injuries:

Proximal pole fractures


Complete scapholunate (SL) ligament  rupture enlarge

Complete scapholunate (SL) ligament rupture.


Scaphoid fractures, or complete SL ligament ruptures with concomitant distal radial fractures. enlarge

Scaphoid fractures, or complete SL ligament ruptures with concomitant distal radial fractures.


Dorsal approach to the scaphoid enlarge

Straight skin incision

Make a straight dorsal skin incision starting over Lister’s tubercle...


Dorsal approach to the scaphoid enlarge

...and extending for about 4 cm distally.


Dorsal approach to the scaphoid enlarge

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.


Dorsal approach to the scaphoid enlarge

Note the radial nerve.


Dorsal approach to the scaphoid enlarge

Incise the retinaculum

Incise the extensor retinaculum over the extensor pollicis longus (EPL) tendon,...


Dorsal approach to the scaphoid enlarge

...opening the distal part of the third extensor compartment.


Dorsal approach to the scaphoid enlarge

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.


Dorsal approach to the scaphoid enlarge

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.


Dorsal approach to the scaphoid enlarge

Take care to preserve the vessels to the dorsal ridge of the scaphoid.
The capsule is not stripped from this area.


Dorsal approach to the scaphoid enlarge

Expose the scaphoid

To expose the proximal pole of the scaphoid, it is necessary to flex the wrist.
The scaphoid now comes into view. Identify the SL ligament.


Dorsal approach to the scaphoid enlarge

Wound closure

Close the capsule with interrupted sutures.


Dorsal approach to the scaphoid enlarge

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.

v1.0 2008-11-08