Authors of section

Authors

Matej Kastelec, Renato Fricker, Fiesky Nuñez, Terry Axelrod

Executive Editor

Chris Colton

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Dorsal approach to the scaphoid

1. Indications

This approach is used for the following injuries:

Proximal pole fractures

Proximal pole fractures

Complete scapholunate (SL) ligament rupture.

Complete scapholunate (SL) ligament rupture

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

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

2. Straight skin incision

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

Dorsal approach to the scaphoid

...and extending for about 4 cm distally.

Dorsal approach to the scaphoid

3. 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

Note the radial nerve.

Dorsal approach to the scaphoid

4. Incise the retinaculum

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

Dorsal approach to the scaphoid

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

Dorsal approach to the scaphoid

5. 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

6. 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

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

7. 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

8. Wound closure

Close the capsule with interrupted sutures.

Dorsal approach to the scaphoid

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.

Dorsal approach to the scaphoid