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J Wrist Surg 2021; 10(02): 176-182
DOI: 10.1055/s-0040-1720964
Emerging Technologies and New Technological Concepts

The Volar Distal Radioulnar Portal in Wrist Arthroscopy: An Anatomical Study

Francisco J. Lucas
1   Unidad de Cirugía de Mano y Miembro Superior, Hospital Quirónsalud Valencia, Valencia, España
,
Vicente Carratalá
1   Unidad de Cirugía de Mano y Miembro Superior, Hospital Quirónsalud Valencia, Valencia, España
,
Ignacio Miranda
2   Servicio de Cirugía Ortopédica y Traumatología, Hospital Arnau de Vilanova Valencia, Valencia, España
,
Cristobal Martinez-Andrade
3   Barcelona and Unidad de Cirugía de Mano y Miembro Superior, Hospital Quirónsalud Valencia, Hospital Dos de Maig Barcelona, Traumaunit Teknon Hospital Barcelona, Barcelona, España
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Abstract

Background Advances in wrist arthroscopy and the emergence of novel surgical techniques have created a need for new portals to the wrist. The aim of this study was to define and verify the safety of the volar distal radioulnar (VDRU) portal.

Description of the Technique The VDRU portal is located ∼5 to 10 mm proximal to the proximal wrist crease, just on the ulnar edge of flexor carpi ulnaris tendon and radial to the dorsal cutaneous branch of the ulnar nerve. The ulnar styloid marks the distal point of the portal.

Methods An anatomical study was performed on 12 upper extremity specimens of 6 human cadavers. Iatrogenic injuries of neurovascular structures potentially at risk were assessed, and the distance from the portal to these structures was measured.

Results No iatrogenic injuries of the structures at risk occurred. Mean distances from the VDRU portal to the ulnar neurovascular bundle, the radial branch of the dorsal sensory branches of the ulnar nerve (DSBUN), and the ulnar branch of the DSBUN were 9.29 ± 0.26 mm, 8.08 ± 0.25 mm, and 10.58 ± 0.23 mm, respectively. There were no differences between left and right wrists. The distances from the VDRU portal to the ulnar neurovascular bundle and the ulnar branch of the DSBUN were significantly shorter in women; this distance was not less than 7 mm in any case.

Conclusions The VDRU portal is safe, reproducible, and facilitates the implementation of various techniques related to triangular fibrocartilage complex pathology.

Keywords

wrist arthroscopy - volar distal radioulnar portal - triangular fibrocartilage complex - radioulnar joint

Note

The work was performed at the Unidad de Cirugía de Mano y Miembro Superior, Hospital QuirónSalud Valencia.




Publikationsverlauf

Eingereicht: 03. Juni 2020

Angenommen: 05. Oktober 2020

Artikel online veröffentlicht:
17. Dezember 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Lucas García F, Carratalá Baixauli V, Sanchez Alepuz E, Calero Ferrandiz R. Generalities, portals and arthroscopic anatomy. Rev Esp Artrosc Cir Articul 2014; 21: 5-13
    CrossrefPubMedSuche in Google Scholar
  • 2 Corella F, Ocampos M, Cerro MD, Larrainzar-Garijo R, Vázquez T. Volar central portal in wrist arthroscopy. J Wrist Surg 2016; 5 (01) 80-90
    Thieme ConnectPubMedSuche in Google Scholar
  • 3 Carratalá Baixauli V, Lucas García F, González Jofré C, Carratalá Baixauli R, Sánchez Alepuz E. Foveal arthroscopic reattachment technique with knotless triangular fibrocartilage with direct view of the distal radio-ulnar join. Rev Iberoam Cir Mano 2016; 44: 39-46
    Thieme ConnectPubMedSuche in Google Scholar
  • 4 Tiznado G, Olave E, del Sol M, Sousa-Rodrigues C. Dorsal branch of the ulnar nerve: a significant contribution to the sensory innervation of the dorsum of the hand. Int J Morphol 2013; 31: 1162-1167
    CrossrefPubMedSuche in Google Scholar
  • 5 Slutsky DJ. Wrist arthroscopy through a volar radial portal. Arthroscopy 2002; 18 (06) 624-630
    CrossrefPubMedSuche in Google Scholar
  • 6 Slutsky DJ. Clinical applications of volar portals in wrist arthroscopy. Tech Hand Up Extrem Surg 2004; 8 (04) 229-238
    CrossrefPubMedSuche in Google Scholar
  • 7 Jantea C, McCarthy D, Herndon J, Horikoshi M. Palmar approaches/portals for arthroscopy of the wrist. Arthroskopie 1994; 7: 225-231
    PubMedSuche in Google Scholar
  • 8 Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am 1989; 14 (04) 594-606
    CrossrefPubMedSuche in Google Scholar
  • 9 Atzei A, Carita E, Papin Zorli I, Cugola L. Arthroscopically assisted foveal reinsertion of peripheral avulsions of the TFCC. J Hand Surg [Br] 2005; 30: 40
    CrossrefPubMedSuche in Google Scholar
  • 10 Atzei A, Luchetti R, Braidotti F. Arthroscopic foveal repair of the triangular fibrocartilage complex. J Wrist Surg 2015; 4 (01) 22-30
    Thieme ConnectPubMedSuche in Google Scholar
  • 11 Carratalá Baixauli V, Lucas García FJ, Martínez Andrade C, Carratalá Baixauli R, Guisasola Lerma E, Corella Montoya F. All-arthroscopic triangular fibrocartilage complex ligamentoplasty for chronic DRUJ instability. Tech Hand Up Extrem Surg 2019; 23 (01) 44-51
    CrossrefPubMedSuche in Google Scholar
  • 12 Colantoni J, Chadderdon C, Gaston RG. Arthroscopic wafer procedure for ulnar impaction syndrome. Arthrosc Tech 2014; 3 (01) e123-e125
    CrossrefPubMedSuche in Google Scholar
  • 13 Luchetti R, Khanchandani P, Da Rin F, Borelli PP, Mathoulin C, Atzei A. Arthroscopically assisted Sauvé-Kapandji procedure: an advanced technique for distal radioulnar joint arthritis. Tech Hand Up Extrem Surg 2008; 12 (04) 216-220
    CrossrefPubMedSuche in Google Scholar