In the case of a dorsally dislocated joint or a fracture-dislocation, gentle traction can often achieve reduction, thus improving blood flow and decreasing traction on digital nerves. The joint is first actively moved through its range of motion while the clinician looks for signs of instability. If displacement occurs, noting the joint angle at which it occurs can help determine an optimal splinting position. Evaluation of the collateral ligaments is performed by passive stressing, using the uninjured hand for comparison. If reduction is not easily achieved, ligament interposition or buttonhole entrapment should be considered, and open reduction may be required.
Interposition is rare in dorsal fractures and fracture-dislocations, but common in volar injuries.
Reduction of volar dislocations is achieved through slackening the extensors by slightly extending the wrist and flexing the metatarsophalangeal and PIP joints to take tension off the lateral bands. A rotation maneuver is then used to achieve reduction. If this fails, open reduction is required. A complete extensor tendon rupture may accompany this injury and cause late deformity. It allows motion through a stable range of flexion while blocking the portion of extension in which the fracture is unstable and dislocates.