Carefully fragment the lunate with a small bone cutter, osteotome, or saw to facilitate removal. Next insert the pin into the triquetrum and excise it in a similar manner. (The lunate and triquetrum are excised first to provide more space for the more difficult excision of the scaphoid.) Now through the more radial of the two incisions in the capsule, first excise the ulnar fragment of the scaphoid in the manner just described above and then the radial fragment, but dissect close to this fragment to avoid injuring the radial artery. Align the capitate with the lunate fossa. Use a Steinmann pin to stabilize the capitate if needed. If the palmar radiocapitate ligament is preserved, this may not be necessary. Obtain hemostasis or drain the wound as needed and close the wound in layers. Apply a sugar-tong splint with the hand and wrist in a functional position.

After treatment:

The wrist is immobilized in slight extension and with the hand in the functional position in a plaster sugar-tong splint for 2 or 3 weeks. If a Steinmann pin has been used, it is removed at about 4 weeks. Active motion of the digits is encouraged soon after surgery and is continued throughout the convalescence. Once the soft tissues have healed, active motion of the wrist is increased gradually. Active exercises to strengthen grip are of utmost importance.