The Relationship Between the Wrist Flexion Creases and the Volar Radiocarpal Joint: A Cadaveric Study

Abstract

Background: Surgical approaches to the volar radiocarpal joint have historically entailed wide exposure, possibly contributing to poor wound healing and wrist denervation. To avoid wound complications and wrist denervation, minimally invasive and percutaneous approaches to the volar radiocarpal joint have been proposed. To help guide these minimally invasive or percutaneous approaches to the joint, we sought to characterize the relationship between the volar wrist flexion creases and the volar radiocarpal joint. We propose that the wrist flexion creases will be a reliable method for localizing the joint.

Methods: Ten cadaveric upper-extremity specimens consisting of fingertip to mid forearm were obtained. Measurements from the proximal and distal wrist flexion creases were taken via fluoroscopy and gross dissection.

Results: The wrist flexion creases were located distal to the volar radiocarpal joint in all specimens. The volar radiocarpal joint was located 7 and 16 mm proximal to the proximal and distal wrist flexion creases, respectively. The radiographic anatomy correlated well with the underlying deep anatomy.

Conclusions: The wrist flexion creases can serve as a reliable superficial landmark for the identification of the volar radiocarpal joint. These landmarks aid clinicians in performing or interpreting a physical examination or in performing minimally invasive or percutaneous approaches to the volar radiocarpal joint.

Keywords: cadaveric study; surgical landmarks; volar radiocarpal joint; wrist flexion.

Figure 1.

Measurement of the distance between the wrist flexion creases and interfossal ridge via fluoroscopy. Note. (a) Placement of the Kirschner wires (K-wires) at the wrist flexion creases and at the interfossal ridge of the radius. (b) Identification of the interfossal ridge of the radius via fluoroscopy. The wrist flexion creases can be visualized via the K-wires traveling transversely.

Figure 2.

Measurement of the distances between the wrist flexion creases and interfossal ridge grossly. Note. After dissection down to the radiocarpal joint, the dye injections were identified. From proximal to distal, the Kirschner wire is located at the interfossal ridge, the first dye marking is at the proximal wrist flexion crease, and the second dye marking is at the distal wrist flexion crease.