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Functional Metacarpal Splint

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Other Names

The functional metacarpal splint[1]
The metacarpal mitt splint[2]
  • Functional Metacarpal Splint (FMS)
  • Metacarpal Mitt Splint
  • Clamshell Splint
  • Boxer's Splint


  • This page describes the so-called functional metacarpal splint
  • This is a U-shaped splint that covers the hand/ metacarpals only
  • The advantage is that the wrist, PIP, and DIP joints are left free while still immobilizing the metacarpals



  • Absolute contraindications
    • None
  • Relative contraindications
    • Open fractures
    • Injuries with neurovascular compromise




  • Measure splint material
    • Measure from the thenar eminence, 1st metacarpal head
    • Wrap around ulnar hand and back up the other side to the 1st metacarpal head
    • You will need 8-10 layers


  • Patient position
    • Wrist is in a neutral position during the procedure
    • None of the joints will be immobilized
  • Stockinette
    • Optional given small size of splint
  • Cast padding/ web roll
    • Apply covering entire volar/dorsal hand
    • Do not cover the MCP joint or wrist joint
    • Create a whole for the thumb to protrude through
  • Plaster of paris
    • Apply on the volar surface starting at the thenar eminence and 1st metacarpal head
    • Wrap around the ulnar hand and back up to the metacarpal head on the dorsal side
  • Apply extra cast padding
  • Fold the stockinette over if used
  • Apply elastic wrap over the splint and web roll
    • Make a whole for the thumb
  • Smooth out the splinting material
  • Confirm distal neurovascular status


  • Try to elevate extremity for the first few days to prevent more swelling
  • Advise patient to keep cast or splint clean and dry
  • Do not insert objects into splint/ cast
  • Monitor for complications (worsening pain, paresthesia/ numbness, color changes)
  • Seek further care if unable to control pain at home


  • Plaster burn/ thermal injury
  • Pressure sores
  • Nerve palsy
  • Vascular compromise
  • Splint dermatitis
  • Permanent joint stiffness

See Also


  1. 1.0 1.1 Kaynak, Gokhan, et al. "Comparison of functional metacarpal splint and ulnar gutter splint in the treatment of fifth metacarpal neck fractures: a prospective comparative study." BMC Musculoskeletal Disorders 20 (2019): 1-10.
  2. The Metacarpal Mitt Splint for 2nd-5th Metacarpal Fractures: A Prospective Case Series Daniel Yang Hong, MD, Chimere O Ezuma, BA, Peter C Noback, MD, Liana J Tedesco, MD and Robert J Strauch, MD, Columbia University Medical Center, New York, NY
Created by:
John Kiel on 22 June 2023 12:19:40
Last edited:
24 June 2023 15:49:48