Executive Editor: Chris Colton

Authors: Renato Fricker, Matej Kastelec, Fiesky Nuñez, Terry Axelrod

Thumb

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Glossary

Palmar approach to the PIP joint

Palmar to PIP joint

The palmar approach is mainly indicated for  avulsion fractures of the volar plate, and for fracture dislocations of the PIP joint, or for  comminuted impacted  fractures of middle phalanx (pilon) fractures.

Dorsal approaches to the PIP joint

Dorsal to the PIP joint

The dorsal approach to the proximal interphalangeal (PIP) joint is indicated for intraarticular fractures.
It is also useful for coronal plane fractures of the condyles of the proximal phalanx.
Central slip avulsion fractures from the dorsal base of the middle phalanx are an ideal indication for this approach.

This approach is indicated for extraarticular fractures of the first metacarpal, and for periarticular fractures of the first carpo-metacarpal joint.

Dorsal to thumb metacarpal

This approach is indicated for extraarticular fractures of the first metacarpal, and for periarticular fractures of the first carpo-metacarpal joint.

Two different skin incisions can be used.

Radiopalmar to the thumb base

This approach is indicated for intraarticular fractures of the first carpo-metacarpal joint, such as the Bennett, or Rolando, injuries.

This approach is indicated for intraarticular, or periarticular, fractures of the metacarpophalangeal (MCP) joint of the thumb.

Dorsal to MCP joint of thumb

This approach is indicated for intraarticular, or periarticular, fractures of the metacarpophalangeal (MCP) joint of the thumb.

This approach is indicated for intraarticular and avulsion fractures.

Dorsoulnar to MCP joint of thumb

This approach is indicated for intraarticular and avulsion fractures.

For proximal fractures, make a skin incision from B to C. For further exposure the incision can be extended to A.

Midaxial to the proximal phalanx

The midaxial approach is indicated for oblique, spiral, comminuted, or transverse fractures, of the diaphysis and metaphysis. It is also indicated

Midaxial approach to the PIP joint

Midaxial to the PIP joint

This approach is indicated for intraarticular basal and condylar fractures.

Percutaneous approach through the finger tip

Percutaneous through finger tip

The percutaneous approach through the finger tip is indicated for K-wire procedures of the distal phalanx.

There are three common skin incisions: The H-shaped, the Y-shaped, and the lazy S-shaped incision.

Dorsal to the DIP joint

The dorsal approach to the distal interphalangeal (DIP) joint is indicated for extensor tendon avulsion fractures of the dorsal base of the distal phalanx, or intraarticular fractures with palmar dislocation.
It is also indicated for DIP arthrodesis.

Make a carefully planned palmar angled skin incision (Bruner zigzag), using the flexor skin crease as a guide, as illustrated.

Palmar to the DIP joint

The palmar approach is indicated for avulsion fractures of the palmar base of the distal phalanx.

This approach is indicated for intraarticular fractures, arthrodesis and avulsion fractures.

Dorsal to IP joint of the thumb

This approach is indicated for intraarticular fractures, arthrodesis and avulsion fractures.

v1.0 2008-11-08