Operative approaches: Hand

In an appropriately marked and consented anaesthetised patient. I would complete a WHO checklist.

  • The patient would be positioned supine with an arm board. Arm exanguated and torniquette to 250mmHg.
  • Incision: Distal palmar crease, kaplans cardinal line (1st webspace to hook of hamate)  and radial border of the 4th digit. Incision needs to be long enough to visualise the proximal and distal border of the transverse carpal ligament.
  • Superficial dissection: subcut fat and palmar tissue. transverse carpal ligament (mcdonald to protect)
  • Washout + closure with 4-0 nylon. wool and crepe
  • Dangers – palmar cutaneous branch 

In appropriately marked and consented and anaesthetised patient.

  • I would complete the WHO checklist.
  • The patient would be supine, arm board, Torniquette up to 250mmHg.
  • Incision would be over the A1 and A5 pulley.
  • Insert a grey cannula into the A1 pulley and irrigate
  • Take samples for MCS
  • Leave open, simple dressings, splint and bradford sling

Closed reduction

  • Finger traps
  • Dorsal dislocations are reduced through wrist extension, traction and then flexion.
  • Apply sugar tong splint 

Open reduction

  • Dorsal approach: Longitudinal incision centred at Lister’s tubercle
  • Volar incision: extended carpal tunnel incision