Approach to distal radioulnar joint specific

The distal radioulnar joint can be exposed dorsally through a 4 cm longitudinal skin incision made between the fifth and sixth extensor

Volar Approach Scaphoid

Fig. 15. (A) Skin incision for volar exposure of the scaphoid (angled line) is centered around the scaphoid tuberosity (circle). (B) The superficial branch of the radial artery and its venae comitantes will cross the incision and will require division. (C) The superficial surface of the flexor carpi radialis tendon sheath is incised longitudinally (dashed line) to allow release of the tendon. (D) The flexor carpi radialis tendon is retracted to allow exposure of the deep volar surface of the tendon sheath. The volar sheath of the flexor carpi radialis is intimately associated with the radioscaphocapitate (RSC) and long radiolunate ligaments (LRL), which need to be divided to expose the scaphoid waist. A longitudinal incision (dotted line) is made in the floor of the sheath, dividing the RSC and LRL. (E) The long radiolunate and the radioscaphocapitate ligament should be sharply incised to allow later repair. Care should be taken not to injure the underlying cartilage of the scaphoid. (F) Complete exposure of the volar surface of the scaphoid is achieved with appropriate retraction. (A-F copyright 2006 Mayo Clinics, reproduced with permission of the Mayo Foundation.)

Fig. 15. (A) Skin incision for volar exposure of the scaphoid (angled line) is centered around the scaphoid tuberosity (circle). (B) The superficial branch of the radial artery and its venae comitantes will cross the incision and will require division. (C) The superficial surface of the flexor carpi radialis tendon sheath is incised longitudinally (dashed line) to allow release of the tendon. (D) The flexor carpi radialis tendon is retracted to allow exposure of the deep volar surface of the tendon sheath. The volar sheath of the flexor carpi radialis is intimately associated with the radioscaphocapitate (RSC) and long radiolunate ligaments (LRL), which need to be divided to expose the scaphoid waist. A longitudinal incision (dotted line) is made in the floor of the sheath, dividing the RSC and LRL. (E) The long radiolunate and the radioscaphocapitate ligament should be sharply incised to allow later repair. Care should be taken not to injure the underlying cartilage of the scaphoid. (F) Complete exposure of the volar surface of the scaphoid is achieved with appropriate retraction. (A-F copyright 2006 Mayo Clinics, reproduced with permission of the Mayo Foundation.)

compartments, extending proximally from the level of the ulnar styloid [32]. The fifth compartment lies right over the distal radioulnar joint. The retinaculum over the fifth compartment should be opened and the extensor digiti minimi tendon should be retracted. An L-shaped ulnar based capsular flap is created by incising the dorsal capsule of the distal radioulnar joint along the radial attachment, leaving a small rim of capsule for subsequent repair. The capsulotomy extends distally to the level of the dorsal radioulnar ligament, which appears as a distinct thickening of the capsule as the sigmoid notch is approached. The capsulotomy extends ulnarly along the proximal edge of the dorsal radioulnar ligament until the sixth compartment is reached.

This exposure will allow unencumbered visualization of the distal radioulnar joint, and by rotating the forearm, the entire surface of the ulnar head articulating with the sigmoid notch of the radius can be visualized. By leaving the dorsal radioulnar ligament, the stability of the joint is not compromised. Direct repair of the capsulotomy is easily completed along the distal and radial extents.

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