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.
2. 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.
3. 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.
4. 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.
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. If an intertendinous connection has been cut, it should be repaired.