Authors of section

Authors

Renato Fricker, Matej Kastelec, Fiesky Nuñez, Terry Axelrod

Executive Editor

Chris Colton

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Dorsal approach to 2nd metacarpal

1. Indications

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

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

2. Surgical anatomy

The dorsal aspect of the second metacarpal can be approached easily, as the two extensor tendons of the index finger run slightly obliquely towards the center of the wrist joint.
The sensory nerve branches and longitudinal veins must be protected.

The dorsal aspect of the second metacarpal can be approached easily, as the two extensor tendons of the index finger ...

3. Skin incision

Make a straight longitudinal skin incision dorsoradial to the second metacarpal bone.

Make a straight longitudinal skin incision dorsoradial to the second metacarpal bone.

4. Retract extensor tendons

The extensor tendons can be retracted to the ulnar side, together with the surrounding loose connective tissue.
If necessary, partially detach the dorsal interosseous muscles subperiosteally from the bone.

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

5. Pitfall: Avoid complete muscle detachment

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

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

6. Wound closure

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

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