Dorsoulnar approach to the 5th metacarpal base

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

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.

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

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.