NEW DORSAL CAPSULOTOMY FOR THE SURGICAL EXPOSURE OF THE WRIST

A reliable, safe approach to the wrist through fiber-splitting dorsal capsulotomies has been developed. The dorsal wrist capsule is exposed by subperiosteally elevating the fourth and fifth extensor compartment s ulnarly and translocating the extensor pollicis longus tendon with t he radial wrist extensor tendons radially. The midcarpal joint and the radial half of the radiocarpal joint are exposed by longitudinally sp litting the dorsal radiocarpal and dorsal intercarpal ligaments, with the apex at the triquetrum. The flap created is elevated radially, det aching the dorsal capsule from the radius to the level of the styloid process, For exposure of the ulnocarpal joint, the dorsal radiocarpal ligament is split longitudinally, and the capsule is incised along the extensor carpi ulnaris tendon subsheath proximally to the lever of th e triangular fibrocartilage, with the apex at the triquetrum. The flap created is elevated proximally. Exposure of the wrist is excellent, s tability of the carpal bones is maintained, and closure is simplified using this approach.