Authors of section

Authors

Renato Fricker, Matej Kastelec, Fiesky Nuñez, Terry Axelrod

Executive Editor

Chris Colton

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Dorsal approach to metacarpals

1. Indications

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

2. Surgical anatomy

The extensor tendons of the 3rd and 4th fingers run dorsally directly over the metacarpals. The extensor tendons of the index and little fingers converge slightly from their metacarpal axes towards the center of the wrist joint.
Be aware of the intertendinous connections, which are located over the distal thirds of the metacarpals.
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 in the interval between adjacent metacarpal bones, not directly over the extensor tendons.
The incisions can be extended proximally and distally in an oblique direction.

Make a straight longitudinal skin incision in the interval between adjacent metacarpal bones, not directly over the extensor ...

Adjacent metacarpals can be approached with a single skin incision.

Adjacent metacarpals can be approached with a single skin incision.

4. Retract extensor tendons

The extensor tendons are retracted together with the surrounding loose connective tissue. If necessary, the intertendinous connection can be divided

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

5. Detach interosseous muscles

Partially detach the dorsal interosseous muscles from the bone subperiosteally.

Partially detach the dorsal interosseous muscles from the bone subperiosteally.

6. 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 ...

7. 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.

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