All approaches to the carpal bones

A minimally invasive palmar approach to the scaphoid is used for screw fixation of minimally displaced fractures of the scaphoid waist. In minimally displaced scaphoid fractures of the proximal third, this may also be an option.

A combined approach to the carpus is not always indicated for perilunate injuries. In the majority of cases, the dorsal approach is made first. Continue with a (palmar) extended carpal tunnel approach if the reduction of the carpal bones could not be achieved with a dorsal approach only.

The dorsal approach to the scaphoid 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.

The palmar approach to the scaphoid is indicated for irreducible, displaced scaphoid fractures in the distal two thirds and comminuted scaphoid fractures.

The ulnar approach to the hamate hook is indicated for excision of the hook. It can also be used for excision of the pisiform in case of posttraumatic sequelae.

In some cases, this approach is used to treat acute fractures.

The dorsal approach to the carpometacarpal (CMC) joints is used to expose and remove any obstruction to reduction in dislocations or fracture-dislocations of the CMC joints.