Closed reduction - Splinting (preliminary treatment)

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 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).

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

Apply a plaster splint in a standard manner.

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.