Executive Editor: Chris Colton

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

Thumb

Overview

Dorsal to thumb metacarpal i

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

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

Radiopalmar to the thumb base i

Two different skin incisions can be used.

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

Dorsal to MCP joint of thumb i

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

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

Dorsoulnar to MCP joint of thumb i

This approach is indicated for intraarticular and avulsion fractures.

This approach is indicated for intraarticular and avulsion fractures.

Midaxial to the proximal phalanx i

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

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

Dorsal to IP joint of the thumb i

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

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

Dorsal to the PIP joint i

Dorsal approaches 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.

Percutaneous through finger tip i

Percutaneous approach through the finger tip

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

Dorsal to the DIP joint i

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

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.

Palmar to the DIP joint i

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

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

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v1.0 2008-11-08