Authors of section

Authors

Fabio A Suarez, Aida Garcia

Executive Editor

Simon Lambert

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Dorsoulnar approach to the 5th metacarpal

1. Indication

This approach is indicated for extraarticular fractures of the 5th metacarpal, especially for extraarticular neck fractures.

It avoids conflict with the extensor mechanism of the metacarpophalangeal (MCP) joint.

Skin incision of a dorsoulnar approach to the 5th metacarpal

2. Surgical anatomy

The insertion of the extensor carpi ulnaris tendon is onto the ulnar base of the 5th metacarpal.

The dorsal sensory branch of the ulnar nerve crosses over the base of the 5th metacarpal.

Ulnar view of the surgical anatomy at the 5th metacarpal and phalanges

3. Skin incision

Start the incision distal to the metacarpal base, lateral in line with the diaphysis.

Continue the incision with a slight dorsal curve as far as the metacarpal head. This will avoid damage to the ulnar collateral ligament and the sagittal band of the extensor mechanism.

Skin incision of a dorsoulnar approach to the 5th metacarpal

4. Exposure of the diaphysis

Be aware of the dorsal sensory branch of the ulnar nerve in the subcutaneous tissue. Mobilize the nerve so it can be moved dorsally and/or palmarly to gain access for plate and screw insertion.

Expose the diaphysis down to the bone.

Exposure of the 5th metacarpal diaphysis and mobilization of the dorsal sensory branch of the ulnar nerve

5. Wound closure

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

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

Cross section showing periosteum covering a plate fixation at the 5th metacarpal base
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