Are open wounds present (possible open fracture, often from ulnar styloid)?

Are there any associated injuries?

Does the patient have paresthesia (concern for acute carpal tunnel syndrome)?

Ensure arm is stabilized, elevated, and iced immediately.

X-rays of the wrist, forearm, and elbow.

Jewelry be removed, IV access on contralateral arm.

2.5–10 mg of IV valium and local hematoma block lidocaine as adjuncts to reduction.

Open fractures: Should be irrigated in ED and receive antibiotics (will require formal irrigation and debridement in OR)

Paresthesia: Acute carpal tunnel syndrome may require emergent fixation and release if it persists after reduction

AP, oblique, and lateral views of the wrist are necessary for evaluation.

Advanced imaging (CT) is generally not required acutely, though it may be useful for operative planning in some complex fracture patterns.

Postreduction X-rays of the wrist (AP and lateral) after reduction.