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Surgical Approach to the Triangular Fibrocartilage Complex

Garcia-Elias, Marc MD, PhD; Smith, Donna E. MD; Llusá, Manuel MD, PhD

Techniques in Hand and Upper Extremity Surgery: December 2003 - Volume 7 - Issue 4 - p 134-140

There are few descriptions of the surgical exposure of the ulnar aspect of the wrist. The anatomy of the dorsoulnar aspect of the wrist was explored in 7 cadaver wrists with special attention to developing a surgical approach to the dorsum of the radio-ulno-carpal joint. Using the experience from previous authors and the knowledge gained from our cadaveric dissections, a surgical approach was designed that provides wide exposure of the dorsoulnar aspect of the wrist. The anatomic layers are dissected in a distinct pattern that allows preservation of the extensor carpi ulnaris and its sheath as well as a strong closure of each layer and restoration of the anatomy. Minimal postoperative immobilization is required, and rehabilitation can be started as early as 2 weeks postoperatively. This approach provides access to the distal radioulnar joint, triangular fibrocartilage complex, distal ulna, and lunotriquetral joint, thus allowing multiple possible procedures through a single, universal approach.

Hand and Upper Extremity Surgery; Institut Kaplan; Barcelona, Spain

Department of Orthopaedics; St. Paul's Hospital; Vancouver, Canada

Anatomy Department; Facultat de Medicina; Universitat de Barcelona; Barcelona, Spain

Corresponding author: Dr. Marc Garcia-Elias, Institut Kaplan, Passeig de la Bonanova, 9, 2-2, 08022 Barcelona, Spain. E-mail:

© 2003 Lippincott Williams & Wilkins, Inc.