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Authors of section

Authors

Pavel Dráč, Matej Kastelec, Fabio A Suarez

Executive Editor

Simon Lambert

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Closed reduction - Splinting (preliminary treatment)

1. General considerations

Closed reduction precedes operative treatment and has the following benefits:

  • Reducing the risk of median nerve injury
  • Restoration of carpal alignment
  • Pain relief
  • Facilitating surgical repair

After emergency reduction, the wrist is immobilized in a palmar plaster splint in the neutral position. For further stability, the proximal phalanx of the thumb can be included in a position of slight opposition (“scaphoid splint”).

The wrist is immobilized in a palmar plaster splint in the neutral position.

2. Closed reduction of the lunate

The dislocated lunate is reduced by distracting and slightly extending the wrist and then applying direct thumb pressure over the lunate from palmar to dorsal.

The wrist is then flexed slightly. The reduction is felt as the lunate relocates. The distraction is then released.

Confirm the lunate relocation with an image intensifier.

If closed reduction is not successful, open reduction via a palmar approach is necessary as soon as possible (due to the risk of median nerve injury).

Closed reduction of a lunate dislocation

3. Splint application

Padding

Pad the arm and hand to avoid pressure sores, especially on the distal ulna and styloid process of the radius.

Padding the forearm and wrist for splint application

Plaster application

Apply a plaster splint in a standard manner.

Applying a plaster splint to the forearm and wrist

Add elastic bandage to hold the splint in position.

Make sure that the splint and bandage do not extend too far distally, both at the levels of the metacarpophalangeal (MCP) joints of the fingers and the interphalangeal joint of the thumb. The splint must allow complete movement of these joints.

Palmar splint allowing for complete movement of the metacarpophalangeal joints of the fingers and the interphalangeal joint of the thumb