Surgical Approach to the Triangular Fibrocartilage Complex

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.