Authors of section

Authors

Fabio A Suarez, Aida Garcia

Executive Editor

Simon Lambert

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Dorsoulnar approach to the 5th metacarpal base

1. Indication

This approach is indicated for:

  • Intramedullary wire fixation of extraarticular fractures of the 5th metacarpal neck
  • Fracture types of the 5th metacarpal base, eg, avulsion fractures
Skin incision of a dorsoulnar approach to the 5th metacarpal base

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.

Dorsoulnar view of the surgical anatomy around the 5th metacarpal base

3. Skin incision

Perform a short longitudinal incision over the dorsoulnar base of the 5th metacarpal.

Skin incision of a dorsoulnar approach to the 5th metacarpal base

4. Exposure of the base

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.

Exposure of the 5th metacarpal base

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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