Authors of section

Authors

Renato Fricker, Matej Kastelec, Fiesky Nuñez, Terry Axelrod

Executive Editor

Chris Colton

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Dorsal approach to the metacarpophalangeal (MCP) joint of the thumb

1. Indications

This approach is indicated for intraarticular, or periarticular, fractures of the metacarpophalangeal (MCP) joint of the thumb.
It is also used for arthrodesis of the MCP joint.

This approach is indicated for intraarticular, or periarticular, fractures of the metacarpophalangeal (MCP) joint of the thumb.

2. Skin incision

A straight, or gently curved, skin incision can be used.
Start the incision 2 cm proximal to the MCP joint, extending it to approximately 2 cm distal to the MCP joint.
Identify and protect the dorsal divisions of the dorsal sensory branch of the radial nerve, and the dorsal veins.

A straight, or gently curved, skin incision can be used.

3. Exposure of the extensors

Elevate the skin and fine subcutaneous tissue as a single layer, by blunt dissection, and expose the tendons of extensor pollicis longus (EPL) and extensor pollicis brevis (EPB).

Elevate the skin and fine subcutaneous tissue as a single layer, by blunt dissection, and expose the tendons of extensor ...

4. Splitting of the tendon

Incise between the EPL and the EPB tendons.

Incise between the EPL and the EPB tendons.

Be careful not to detach the insertion of the EPB from the base of the proximal phalanx.

Be careful not to detach the insertion of the EPB from the base of the proximal phalanx.

5. Capsulotomy

After separating the extensor tendons, the joint capsule is exposed. A longitudinal capsulotomy is performed to enter the joint.
Take care not to detach the collateral ligaments.

Take care not to detach the collateral ligaments.

Exposure of the joint

Flex the thumb in order to expose the MCP joint fully.

Flex the thumb in order to expose the MCP joint fully.

6. Wound closure

Repair the capsulotomy with fine, interrupted mattress sutures. The separated tendons of EPL and EPB are approximated with sutures.

Repair the capsulotomy with fine, interrupted mattress sutures. The separated tendons of EPL and EPB are approximated with ...