Executive Editor: Jörg Auer

Authors: Wayne McIlwraith, Dean Richardson, Anton Fürst, Larry Bramlage

Metacarpals/Metatarsals

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Glossary

Stab incisions

Usually, stab incisions only are sufficient for fracture repair of the lateral metacarpal/metatarsal condyle supervised arthroscopically as well as for screw fixation of incomplete fractures of the medial metacarpal/metatarsal condyle and Salter Harris Type II fractures of Mc/MtIII. Stab incisions are also used for the treatment of angular limb deformities by growth retardation or acceleration.
More details about the incisions are described in the respective procedures.

Dorsolateral approach

This approach is generally suitable for medial incomplete as well as medial spiral condylar fracture. The exposure may vary upon fracture configuration.

Approaches to the splint bones

Depending on the fracture location and the treatment option chosen, the approach to the splint bone varies. See a summary of the most common approaches.

Open approach

The skin is incised along the entire fractured bone avoiding joint penetration and trauma to the distal physis.
The periosteum is usually ruptured in the fracture region. Care should be taken to avoid additional extensive trauma to the periosteum, such as complete stripping of the periosteum around the circumference of the fractured bone.

Note: Locking Compression Plates can be applied over the periosteum. Alternately, only the area that will be located under the plate(s) can be stripped off the periosteum.

Stab incision prox. metaphysis

A stab incision is prepared down to the underlying bone at the level of the most proximal staple.

Incision prox. metaphyseal spike

In displaced fractures a small incision is made at the level of the proximal metaphyseal spike. This allows accurate reduction of the fracture. A more extensive incision can be made if reduction proves to be difficult.

Incision for minimally invasive

After anatomically reducing and temporarily fixing the fracture with the help of pointed reduction forceps tharough3 cm skin incision at the level of the fracture, the interfragmentary 3.5 mm cortex screws are inserted in a location not covered by a plate.

Stab incision in the diaphysis

The skin is incised along the entire fractured bone avoiding joint penetration and trauma to the distal physis.
The common digital extensor tendon is split longitudinally facilitating good closure over the repaired bone at the end of the surgery
The periosteum is usually ruptured in the fracture region. Care should be taken to avoid additional extensive trauma to the periosteum, such as complete stripping of the periosteum around the circumference of the fractured bone.

Note: Locking Compression Plates can be applied over the periosteum. Alternately, only the area that will be located under the plate(s) can be stripped off the periosteum.

Approach to McMtIII diaphysis

The incision is made directly down to the bone usually splitting the common digital extensor tendon from the lateral or simply splitting the edge of the combined tendon. If it is a more lateral fracture, the incision is made completely lateral to the tendons.

Stab incision for ALD treatment

A small skin stab incision is performed directly over the location where each screw is inserted. If a staple is inserted the skin incision is centered over the physis and adjusted in length according to the length of the staple.
All incisions are carried down to the underlying bone.

Stab incision for ALD treatment

The surgery is performed at the concave (shorter) side of the bone.
The incisions for the two techniques that will be described in the surgical technique are carried out at the same level of the bone, about 2 cm proximal to the physis involved.

Approach for osteotomies

The skin incision is made dorsolaterally over the common/long digital extensor tendon. The incision extends from the carpo-metacarpal/-tarsal joint to the distal McIII/MtIII physis.

Approach to the fetlock joint

Since the fetlock joint will not fully open in any position, the collateral ligament is detached using an iatrogenic condylar fracture, which is created with a bone saw.

Note: An alternate technique involves the transection of the lateral collateral - and the metacarposesamoidean ligament, instead of the iatrogenic condylar fracture.

v1.0 2013-02-02