Executive Editor: Chris Colton

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

Metacarpals

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Glossary

Dorsal to 5th metacarpal
The dorsal approach is indicated for oblique, spiral, comminuted, or transverse fractures of the diaphysis and metaphysis of ... enlarge

Indications

The dorsal approach is indicated for oblique, spiral, comminuted, or transverse fractures of the diaphysis and metaphysis of the fifth metacarpal.
It can also be used for corrective osteotomies of malunited fractures.


The extensor tendons of the little finger converge slightly towards the center of the wrist joint. The dorsal sensory ... enlarge

Surgical anatomy

The extensor tendons of the little finger converge slightly towards the center of the wrist joint.
The dorsal sensory branches of the ulnar nerve  and longitudinal veins must be protected.


Make a straight longitudinal skin incision, dorso-ulnar to the fifth metacarpal bone. The incision can be extended proximally .. enlarge

Skin incision

Make a straight longitudinal skin incision, dorso-ulnar to the fifth metacarpal bone.
The incision can be extended proximally and distally in an oblique manner.
The dorsal sensory branches of the ulnar nerve are especially vulnerable in the proximal third of the incision.


The extensor tendons can be retracted to the ulnar side, together with the surrounding loose connective tissue. enlarge

Retract extensor tendons

The extensor tendons are retracted radially together with the surrounding loose connective tissue.


If necessary, partially detach the abductor digiti minimi and opponens muscles subperiosteally. enlarge

If necessary, partially detach the abductor digiti minimi and opponens muscles subperiosteally.


Avoid complete muscle detachment and injury to the volar structures. Use short, blunt retractors (Langenbeck) rather than ... enlarge

Pitfall: Avoid complete muscle detachment

Avoid complete muscle detachment and injury to the volar structures.
Use short, blunt retractors (Langenbeck) rather than Hohmann levers.


Cover the implant with the periosteum, as far as possible; this helps to minimize contact between the extensor tendons and ... enlarge

Wound closure

Cover the implant with the periosteum, as far as possible; this helps to minimize contact between the extensor tendons and the implant.
If an intertendinous connection has been cut, it should be repaired.

v1.0 2008-11-08