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