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.
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.
3. Skin incision
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.
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.
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.