The dorsomedial full-thickness incision allows access to the 1st TMT and medial area of the 2nd TMT. The dorsolateral full-thickness incision allows access to the lateral area of the second TMT. Work back and forth to reduce and fix the 2nd TMT taking care not to undermine the middle area between the incisions. Care should be taken not to disturb the neurovascular bundle between the incisions in the flap.
The joints can be distracted with a bone spreader allowing access to soft-tissue interposition and bony fragments. These can be debrided and removed to allow perfect reduction of the base of the 2nd MT into the “keystone” corner of the TMT joint.