Anatomy and approaches of the wrist

A thorough knowledge of the anatomy of the wrist is key to performing successful approaches to the complex tendon, ligament, neural and articular structures of the wrist. Several approaches have been described in the literature employing a range of anatomical planes. These approaches can be categorized into dorsal, volar and specialized approaches. Eight surgical approaches within the three categories are described in this article. The relevant anatomy for each approach is described, including details of vascular, neural, osseous, articular and ligamentous relations. This is followed by description of the surgical approaches to the distal radius, distal radio-ulnar joint, carpal tunnel, Guyon's canal, volar distal radius, volar scaphoid, dorsal scaphoid and de Quervain's release.