Dorso-ulnar approach to 5th metacarpal base

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

The insertion of the extensor carpi ulnaris tendon is onto the ulnar base of the fifth metacarpal. The sensory dorsal branch of the ulnar nerve crosses over the base of the fifth metacarpal.

Make a short longitudinal incision over the dorso-ulnar base of the fifth metacarpal.

Be aware of the dorsal sensory branch of the ulnar nerve in the subcutaneous tissue, and use blunt dissection to expose the insertion of the extensor carpi ulnaris tendon.