Authors of section

Authors

Richard Buckley, Andrew Sands, Michael Castro, Christina Kabbash

Executive Editors

Joseph Schatzker, Richard Buckley

Open all credits

Lateral approach to the 5th metatarsal

1. Indications

The lateral approach to the fifth metatarsal is used for the fixation of fractures of the fifth metatarsal and diaphyseal osteotomies.

orif plate fixation

2. Preservation of the vitality of the soft tissues and of the bone

Excessively wide, deep exposures and over-retraction should be avoided.
Multiple specific sites in the foot are better approached through separate incisions, in the interests of avoiding additional soft-tissue damage
In the foot, it is of paramount importance to preserve good venous drainage.

Multiple specific sites in the foot are better approached through separate incisions...

3. Anatomy

The short saphenous vein lies subcutaneously in the line of the approach. The fascia covering the abductor digiti quinti muscle is found just deep to the vein.
Branches of the sural nerve must be sought and preserved in the surgical field.

Anatomy

4. Skin incision

The skin incision starts just proximal to the styloid process of the base of the fifth metatarsal and proceeds distally, as far as required.
The incision is made at the junction of the dorsal skin and the plantar skin.

The skin incision starts just proximal to the styloid process of the base of the fifth metatarsal and proceeds distally.

5. Deep dissection

Expose of the fascia over the abductor digiti quinti muscle belly, and incise it longitudinally.

Expose of the fascia over the abductor digiti quinti muscle belly, and incise it longitudinally.

6. Bony exposure

Using Langenbeck retractors, retract the skin and fascia dorsally, and the muscle belly in a plantar direction, exposing the underlying fifth metatarsal.

Using Langenbeck retractors, retract the skin and fascia dorsally, and the muscle belly in a plantar direction, exposing...