All approaches to the metacarpals

This approach is used for intraarticular fractures of the 5th metacarpal base, fracture-dislocations of the 5th carpometacarpal joint, and tendon avulsion fractures of the extensor carpi ulnaris. It can also be used for the rare displaced extraarticular fractures of the 5th metacarpal base.

The dorsal approach to the carpometacarpal (CMC) joints is used to expose and remove any obstruction to reduction in dislocations or fracture-dislocations of the CMC joints.

This approach is indicated for intraarticular fractures of the metacarpal head, injuries of the metacarpophalangeal collateral ligaments (either avulsion fractures or ligament ruptures), and intra- or extraarticular fractures of the base of the proximal phalanx.

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

The dorsoulnar approach to the 5th metacarpal base is indicated for extraarticular fractures of the 5th metacarpal neck if intramedullary wire fixation is performed. It may also be used for other fracture types, such as avulsion fractures of the 5th metacarpal base..

The radial approach exposes the distal 2/3 of the 2nd metacarpal. It is indicated for open treatment of oblique, spiral, comminuted, or transverse fractures of the diaphysis and neck or head of the 2nd metacarpal. It can also be used for corrective osteotomies of malunited fractures. This approach avoids conflict with the extensor mechanism of the metacarpophalangeal joint.

The ulnar approach to the 5th metacarpal is indicated for extraarticular fractures, especially for neck fractures. This approach avoids conflict with the extensor mechanism of the metacarpophalangeal joint.

The volar approach is used for the surgical treatment of fracture-dislocations of the metacarpophalangeal joint.