Adductovarus fifth digits are very common in the clinic for the foot and ankle surgeon. The derotational fifth arthroplasty is a simple surgery that we do in our minor procedure room for rigid type deformities. Here, we demonstrate the procedure using a local block with epinephrine, yet this may be done with a Penrose drain as well.
The key to accessing the proximal phalanx head is through an elliptical oblique incision. The incision must be at least the width of the head of the proximal phalanx in an oblique fashion. Also, the amount of tissue resected in the ellipse also correlates to the amount of rotation that must be reduced from the deformity. Therefore, the more adduction and varus of the digit, the larger the ellipse of tissue to be resected.
There’s nothing more frustrating than battling a procedure because of an ill placed incision. Proper exposure in surgery is everything. Hopefully this video will demonstrate how to continue to make the derotational fifth digital arthroplasty in your clinic a simple, reproducible, and efficient procedure.
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