Ulnar Gutter Cast

Other Names

Stockinette for the ulnar gutter cast

Completed ulnar gutter cast

Step by step instructions for the shortened ulnar gutter cast

• Ulnar gutter Cast
• Short Ulnar Gutter Cast

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Background

• This page refers to the ulnar gutter cast
  • This is the cast equivalent of the ulnar gutter splint
  • When indicated, typically placed a few days after the acute injury to allow swelling to go down
• Length
  • Typically extends from distal phalanx of digits 4/5 up to mid forearm
  • The so-called short ulnar gutter can extend just proximal to wrist

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Indications

• Boxers Fracture
• 4th or 5th metacarpal fractures
  • Nondisplaced fractures of the head, neck, and shaft
  • Without significant angulation or rotation
• 4th or 5th proximal and middle phalanx fractures
  • Nondisplaced, nonrotated
• Nondisplaced Distal Ulna Fracture

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Contraindications

• Most acute fractures
• Open fractures
• Injuries with neurovascular compromise
• Fractures with active swelling

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Procedure

Equipment

• See: Casting materials

Technique

• Patient position
  • Splint is in intrinsic plus (4/5th digit in 70° flexion at MCP, 20-30° extension at wrist)
  • 1-3rd digit are freely mobile
• Stockinette/ tubular bandage
  • Extend stockinette up mid/proximal forearm
  • Extend down past 4th and 5th digit
• Cast padding
  • Wrap circumferentially from distal to proximal
  • Typically a single layer of padding is sufficient
• There should be no creases in the stockinette or cast padding
• Cast material
  • Wrap from distal to proximal
  • Trim excess material to accommodate distal thumb and fingers
  • Fold the proximal and distal ends of the stockinette over the cast
  • Apply an additional layer of cast material
• Apply a 3 point fixation at the fracture site until the material hardens
• Consider placement in a shoulder sling
• Confirm neurovascular exam

Pearls and Pitfalls

• Consider a Shoulder Sling for comfort

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Aftercare

• Typically non-weight bearing until re-evaluated
• 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

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Complications

• Acute Compartment syndrome
  • The ability to passively/actively extend fingers without discomfort indicates absence of muscle compartment compression
• Plaster burn/ thermal injury
• Pressure sores
• Nerve palsy
• Vascular compromise
• Splint dermatitis
• Permanent joint stiffness
• Skin infection
  • Cellulitis from underlying wound, pressure ulcers

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See Also

• Casting Main
• Procedures Main

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