The natural history of scapholunate ligament injury is unknown. In fact, as far as we can tell, there has been no study examining the long-term natural history of this condition. It has, however, been assumed that the long-term progression of this injury leads to secondary osteoarthritis – scapholunate advanced collapse (the so-called SLAC wrist). In this study, we evaluated the clinical condition of 11 patients with proven scapholunate ligament injuries that had declined further treatment in an attempt to quantify any long-term disability. Whilst there was on-going pain and functional limitation in the injured wrist, there was no rapid progression of the osteoarthritis or SLAC wrist deformity.

An anatomical cadaver dissection was used to compare two approaches to the volar aspect of the distal radius. The traditional approach between flexor carpi radialis and the radial artery limits the exposure of the ulnar aspect distal radius. In the trauma setting, it is difficult to perform a carpal tunnel release whilst protecting the palmar branch of the median nerve and gain sufficient exposure of the volar ulnar fragments and the DRUJ. An extensile ulnar sided approach to the distal radius is described which permits wide exposure of the volar aspect of the distal radius including the DRUJ and radial styloid. This exposure utilises the plane between flexor carpi ulnaris/ulnar neurovascular bundle and flexor digitorum profundus. It permits easy and safe release of the carpal tunnel and Guyon’s canal.

Its use in the trauma and post traumatic setting will be shown with intra-operative pictures.