Time: 20 mins
Personnel Required: 1
Equipment Required:
1. ETCO2 + monitor for procedural sedation
Steps:
1. Place one hand over the proximal forearm.
2. Place other hand to pull traction on the distal forearm.
3. Recreate the injury motion away from midline.
4. Continue to apply traction and pull it back to midline.
5. Apply double sugar tong splint and perform a neurovascular exam.
Time: 10 mins
Personnel Required: 2 or 1 (with finger traps and weight)
Equipment Required:
1. Alcohol Wipe/Chloraprep
2. 18/20G needle
3. 10cc syringe
4. 1% lidocaine with or without epinephrine. 10-20 cc.
Steps:
1. Assistant: Provide countertraction at the elbow at 90° flexion. If no assistant, consider finger traps and 10 lbs of weight suspended at the elbow.
2. Operator: Place thumbs on dorsal fragment on the dorsal side.
3. Wrap fingers around wrist and recreate the injury motion by hyperextending the hand.
4. Then apply downward pressure to bring the distal end back to midline.
5. Immobilize in sugar tong splint with 25° of forearm pronation, 15° of forearm pronation, and 15° of ulnar deviation.
6. Perform a post reduction neurovascular exam.
Surgery Indications: >2mm displaced intra-articular fractures, >3mm dorsal displacement, >10° angulation after reduction.