ED Management

Perform basic management for all hand injuries includes edema reduction, pain control, and removing jewelry or splints.

Reduction is required to prevent long-term sequelae such as post-traumatic arthritis, nerve injury, joint stiffening, or laxity leading to recurrent dislocations.

For reduction, a radial, median, or ulnar nerve block, depending on the location of the injury, will help provide analgesia to enable reduction attempts.

Reduction requires axial traction of the affected digit with volar-directed (if dorsally dislocated) pressure at the base of the metacarpal.

After reduction, place a splint to immobilize the affected CMC joint and the joints distal and proximal.  Refer for routine hand specialist follow up to determine the need for wire fixation versus conservative management.

Post-reduction images: