The incision is centered over the palpable swelling if it can be identified. If the fracture cannot be palpated, a small grid of sterile skin staples can be placed following aseptic preparation of the surgical site and a radiograph taken to identify the exact location for the incision.
2. Skin incision
The incision is made directly down to the bone usually splitting the common digital extensor tendon from the lateral or simply splitting the edge of the combined tendon. If it is a more lateral fracture, the incision is made completely lateral to the tendons.
The incision is approximately 4 cm in length and should go all the way down to the bone. The scalpel can be turned over and the end of the handle used as a periosteal elevator. Alternatively the surgeon can use a standard elevator to expose the surface of the bone.
The actual fracture can only rarely be seen. Usually the surgeon can palpate the small callus on the surface of the bone. Spreading of the edges of the incision with a sharp Weitlaner retractor is useful.