title: Transseptal dorsal approaches to the wrist.
abstract: BACKGROUND
  The dorsal approach to the wrist is the exposure of choice for most of the surgical procedures on the radiocarpal and intercarpal joints. Contrary to the volar approach, it encounters neither the main arteries nor the motor nerve branch. However, the dorsal approach goes necessarily through the extensor retinaculum. We describe two transseptal dorsal approaches that pass through the extensor retinaculum in the thickness of a septum between two compartments. A virtual space was developed beneath the infratendinous retinaculum (which is a deep layer covering the floor of the extensor compartments) to expose the periosteum, the ligaments and the joint capsule without opening the extensor compartments.
  
  
  METHODS
  Twenty cadaveric wrists have been dissected to study the feasibility of the two transseptal approaches. Ten wrists were exposed through a 3-4 transseptal approach, passing through the extensor retinaculum in the thickness of the septum between the third and fourth compartments. Ten wrists were exposed through a 4-5 transseptal approach, passing through the extensor retinaculum in the thickness of the septum between the fourth and fifth compartments. The extent of violations of extensor compartments and joint capsule, and the exposed anatomical structures were noted. At the end of each dissection, the whole extensor system was outrightly removed for histological study.
  
  
  RESULTS
  The feasibility of the transseptal approaches was demonstrated for all the dissected wrists. The dissection plane beneath the infratendinous retinaculum was macroscopically and microscopically highlighted.
  
  
  CONCLUSIONS
  The transseptal approaches provide a good exposure to the dorsal side of the wrist joint, without opening the extensor tendon compartments.
authors.affiliation: Department of Orthopaedic Surgery, Brest University Hospital, Brest, France. ahmed.zemirline@gmail.com
authors.forename: Ahmed
authors.initials: A
authors.lastname: Zemirline
authors.forename: Gérard
authors.initials: G
authors.lastname: Hoël
authors.forename: Kiyohito
authors.initials: K
authors.lastname: Naïto
authors.forename: Arnaud
authors.initials: A
authors.lastname: Uguen
authors.forename: Philippe
authors.initials: P
authors.lastname: Liverneaux
authors.forename: Dominique
authors.initials: D
authors.lastname: Le Nen
mesh_terms: D006801:Humans; D014953:Wrist / Q000033:anatomy & histology / Q000601:surgery*; D014955:Wrist Joint / Q000033:anatomy & histology / Q000601:surgery*