This extended dorsal approach can be used for wrist fusions or for joint-spanning plate fixation of comminuted intra-articular distal radius fractures.
When mobilizing the skin flaps, make sure not to injure the superficial radial nerve.
The third compartment is opened completely in line with the EPL tendon in the extensor retinaculum.
When opening the tendon sheath, be careful not to cut the tendon.
The incision is extended proximally in line with the EPL tendon.
The extensor pollicis longus tendon (EPL) is freed and a vessel loop is passed around it.
The tendon is pulled towards the radial side.
The fourth compartment is elevated subperiosteally, leaving the compartment itself intact. The intermediate column is now exposed.
The tendons of the 4th extensor compartment are held to the ulnar side.
If necessary, the tendons of the second extensor compartment are mobilized to the radial side.
The periosteum is incised on the dorsal side of the third metacarpal and the interosseous muscles elevated subperiostally if necessary.