**3. Setup and equipment**

Wrist arthroscopy requires standard arhroscopic equipment – arthroscopy column with monitor, video camera, video and photo recordingdevice, light source with fiber optic cable which nowadays can be integrated in one small box motorized shavers, radiofrequency ablators and X-Ray C arm and traction system. The patient is positioned supine on the operation table with the affected arm on a hand table. The arm is abducted 90° and the elbow flexed 90° allowing a vertical position of the forearm, wrist and hand. In this position the wrist is kept in neutral prono-supination. The surgeon is positioned at the head of the patient with the assistant beside or facing the surgeon. The arthroscopy column may be on the other side of the patient facing the surgeon (**Figure 1**). X-ray C arm is used when necessary and is not in the way of the staff all the time (**Figures 2** and **3**).

Arthroscopic wrist procedures usually are performed under the regional block anesthesia with a pneumatic tourniquet placed on the upper arm, but there are surgeons who propose to do wrist arthroscopies under portal site local anesthesia (PSLA) without tourniquet [4]. Traditionally wrist arthroscopies were performed using irrigation, but it can be easily inspected and treated also in "dry technique" [5]. However, dry arthroscopy also has its limits. For example when radiofrequency ablators are used, water is necessary as milieu conductor and to prevent temperature peaks and possible joint damage. Also when using a burr the aspiration may be blocked by small cartilage and bone fragments and water facilitates the aspiration [6].

**Figure 2.** *Standard setup and position of the staff during the wrist arthroscopy.*

**Figure 3.** *Use of C arm during the surgery.*

**Figure 4.** *Different finger traps and traction devices (4a - K.L.Martin; 4b -Smith & Nephew).*

Arthroscopic manipulations in wrist require vertical traction to separate bones and create space for instruments and scope. The traction applied is usually 3.5 to 7 kg for wrist joint and 2 to 3 kg for the thumb [6, 7]. There are different types of wrist vertical traction towers – with Chinese finger traps or special traction hands for all fingers. Authors use K.L.Martin and Smith & Nephew wrist traction towers (**Figure 4a**, **b**).
