As the manufacturer of this device, Integra LifeSciences Corporation does not practice medicine and does not recommend this or any other surgical technique for use on a specific patient. The surgeon who performs any procedure is responsible for determining and using the appropriate technique in each patient.

Caution: Federal law restricts this device to sale by or on the order of a physician or practitioner.

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Surgical Approach Pre-Operative Considerations The surgeon should discuss with the patient the alternative treatment options and expectations from surgery. Radiographs are helpful to determine which joints are pathologic and must be eliminated. Discussing the patient’s goals while taking into account the condition of the soft tissues and bones, the surgeon can determine the best approach and implant to use. Prophylactic antibiotics are recommended. Fluoroscopic image intensification is suggested to aid in ideal placement of the implant and positioning of the carpus relative to the radius.

Approach The patient is placed supine on the operating table with the upper extremity extended and pronated to provide access to the dorsum of the wrist A dorsal longitudinal incision is made over the radius extending approximately from 3cm proximal to, Lister’s tubercle to the neck of the 3rd metacarpal (Figure 1) The 3rd dorsal compartment is opened and the EPL tendon is retracted radially Lister’s tubercle is removed with a rongeur, and cancellous autograft can be harvested The 2nd and 4th extensor compartments are dissected off the radius sub periosteally and the interval between the tendons of the 2nd and 3rd dorsal compartments and the 4th dorsal compartment is utilized to expose the dorsal capsule The capsule is incised longitudinally exposing the dorsal wrist The 3rd metacarpal periosteum is elevated to facilitate plate placement

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Bone Preparation Remove any remaining cartilage from the articulations to be fused Figure 2 illustrates joints that should always be fused during a radiocarpal arthrodesis as well as joints that can optionally be fused based on surgeon preference A small osteotome can be used to denude the carpals Fenestrate the subchondral bone with a K-wire or decorticate it with a small bur Irrigate thoroughly and suction dry Reduce the carpals on the radius