Flexor Carpi Ulnaris Tenodesis Stabilization of the Resected Distal Ulna

An incision is made over the flexor carpi ulnaris (FCU) tendon extending to the distal wrist crease.

Avoid cutting or placing excess traction on the dorsal cutaneous branch of the ulnar nerve as it passes obliquely over the ulnar border of the wrist.

Figure 22-1

Dissect the FCU from the pisiform to its musculotendinous junction (Fig. 22-1).
Split the tendon longitudinally in half and cut one half at its musculotendinous junction, producing a tendon strip ~10 cm long.
Pass the FCU strip dorsal through a window created in the connective tissue deep to the ulnar artery and nerve.
A dorsal incision is made to expose the ulnar head or neck.
Excise the ulnar head if it has not been done previously as described for the Darrach procedure.
Drill a large oblique hole through the dorsoradial cortex ~ 1.5 cm from the end of the neck; direct the drill to exit through the open end of the medullary canal (Fig. 22-2).