When a TSPLD has occurred, it is necessary to attempt immediate reduction of the scahoid fracture. This is necessary to avoid progressive swelling and kinking of the remaining blood supply to the scaphoid, which can potentially result in necrosis of the scaphoid bone.
This is rarely achieved by closed manipulation in the emergency room and requires the patient to be brought to the operating room for treatment. The median nerve responsible for the commonly known carpal tunnel syndrome, is located in the same vicinity, is also assessed for acute traumatic compartment carpal tunnel syndrome and is decompressed if necessary.
If the bones are successfully repositioned at the emergency room, the patient can be splinted for comfort and final treatment scheduled within days once the swelling has subsided.
If surgery is required, the surgeon will fix the scaphoid fracture (open reduction and internal fixation) and the injured ligaments in combination with pins to maintain carpal bone alignment while the ligaments that are repaired can heal in good position.
Immobilization for 8 – 12 weeks is done to allow for ligamentous healing. During initial healing, the wrist should remain supported by a splint with minimal motion allowed; the pins can easily toggle, loosen and become infected. The pins are removed after 8-12 weeks when enough time has elapsed for the ligaments to heal.