A safe, simple and cost-effective method of set up for wrist arthroscopy

Abstract

The appropriately anaesthetised patient is positioned supine with an arm table attached on the operative side. An above elbow tourniquet is applied. A drip stand is then attached to the table at the level of the shoulder on the surgical side. The limb is prepared and draped, such that the sterile sheets completely cover the drip stand. Chinese finger traps are then placed upon the index and middle fingers. A four-inch crepe bandage is securely tied in to a loop and then hung from the drip stand. The finger traps can then be suspended from this so that the elbow is approximately six-inches from the arm table (Figure 1). The remainder of the four-inch crepe bandage is looped around the upper limb and tied underneath the arm table in to another loop, from which counter-traction weights can be suspended (Figure 2). We recommend sufficient counter traction such that the metacarpophalyngeal (MCP) joints of the index and middle fingers are both palpably and visibly distracted (Figure 3). This should enable adequate joint distraction, in addition to being able to manipulate the wrist in both coronal and sagittal planes as required during arthroscopic assessment. The set-up and traction is now complete, providing excellent access for portal placement and subsequent safe arthroscopy. This avoids the scuffing of the wrist and carpus that may occur when instruments are inserted in the context of suboptimal traction.