54 Total Wrist Arthroplasty

• A dorsal, longitudinal 10 to 12 cm skin incision is made centered over Lister’s tubercle.
  
• The extensor retinaculum is raised as a radially based flap from the sixth to the second compartments.
  
• The entire dorsal wrist capsule is raised as a distally based rectangular flap, including the periosteum over the distal radius, and, if the ulna is to be resected, the dorsal distal radioulnar joint (DRUJ) capsule (Fig. 54-1).
  
• For the Universal 2 total wrist system (KMI; Kinetos Medical Inc., Carlsbad, California), the intramedullary guide rod is inserted and the radial cutting guide is applied to resect the radius distal articular surface (Fig. 54-2A,B).
  
• Reinsert the guide rod and broach the radius to the proper size (Fig. 54-3).
  
• Insert the radial component trial; remove after confirming proper fit.

Figure 54-1

Figure 54-2

Figure 54-3

Pearl

The articular surface of the distal ulna is removed if there is distal radioulnar joint (DRUJ) arthrosis or severe erosion of the radius.

Related posts:

Intra-articular Fractures of the Distal Radius Treated with Dorsal Plate Resect Ulnar Styloid Fracture with Repair of Triangular Fibrocartilage Complex Sauve-Kapandji Procedure Darrach Procedure (Distal Ulna Resection) Scaphocapitate Fusion with Lunate Excision Ligament Reconstruction

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