Authors of section

Authors

Fabio A Suarez, Aida Garcia

Executive Editor

Simon Lambert

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Radial approach to the 2nd metacarpal

1. Indications

This approach exposes the distal 2/3 of the 2nd metacarpal.

It is indicated for open treatment of the following fracture types of the diaphysis and metaphysis:

  • Oblique
  • Spiral
  • Transverse
  • Multifragmentary

It can also be used for corrective osteotomies of malunited fractures.

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

Skin incision of a radial approach to the 2nd metacarpal

2. Surgical anatomy

The radial aspect of the 2nd metacarpal can be approached easily, as the two extensor tendons of the index finger run slightly obliquely toward the center of the wrist joint.

Note: The dorsal radial sensory nerve branches and longitudinal veins must be protected.
Radial view showing the surgical anatomy at the 2nd metacarpal

3. Skin incision

Start the incision dorsal to the center of rotation of the MCP joint. Continue with a straight longitudinal skin incision radial to the diaphysis.

Skin incision of a radial approach to the 2nd metacarpal

4. Retraction of extensor tendons

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

If necessary, partially detach the dorsal interosseous muscles subperiosteally from the bone.

Take care to protect the radial cutaneous sensory nerve during dissection.

If exposing the metacarpal neck, protect the sagittal bands.

Retraction of extensor tendons during a radial approach to the 2nd metacarpal

Pitfall: Avoid complete muscle detachment

Avoid complete muscle detachment and injury to the volar structures.
Use short, blunt retractors (Langenbeck) rather than Hohmann levers.
Use of Langenbeck retractors instead of Hohmann levers to avoid complete muscle detachment during a radial approach to the 2nd metacarpal

5. Wound closure

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

Periosteum covering a plate at the 2nd metacarpal
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