The proper implant size is estimated preoperatively
using x-ray templates. With the carpal system
aligned with the center of the capitate, the Ulnar
Screw should enter the proximal pole of the hamate.
In the AP view, the radial component should not
extend beyond the edge of the radial styloid.
The carpal component should not extend more than
2 mm over the margins of the carpus at the level
of the osteotomy. In general, select the smaller
implant size when deciding between two sizes.
General Recommendations
Prophylactic antibiotic is administered. Either
general or regional anesthesia is appropriate.
A nonsterile tourniquet is used. A strip of transparent
adhesive film is applied to the dorsum of the
hand and wrist to protect the skin from damage
during instrumentation. Fluoroscopy is a helpful
adjunct to confirm positions of the guides and
implants. Save all resected bone during the procedure
for use in bone grafting the carpus to achieve
an intercarpal arthrodesis.
Surgical Incision
A dorsal longitudinal incision is made over
the wrist in line with the 3rd metacarpal, extending
proximally from its midshaft
The skin and subcutaneous tissue are elevated
together off the extensor retinaculum, with care
to protect the superficial radial nerve and the
dorsal cutaneous branch of the ulnar nerve
The ECU compartment is opened along its volar
margin and the entire retinaculum is elevated
radially to the septum between the 1st and 2nd
extensor compartments (Figure 1)
Each septum is divided carefully to avoid creating
rents in the retinaculum, especially at Lister’s
tubercle, which may need to be osteotomized
An extensor tenosynovectomy is performed if
needed, and the tendons are inspected. The ECRB
must be intact or repairable (preferably the ECRL
is also functional). Vessel loops are used to
retract the extensor tendon.
