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Ulnar Gutter Cast

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Other Names

Stockinette for the ulnar gutter cast[1]
Completed ulnar gutter cast[2]
Step by step instructions for the shortened ulnar gutter cast[3]
  • Ulnar gutter Cast
  • Short Ulnar Gutter Cast

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

Indications


Contraindications

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

Procedure

Equipment

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


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

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

See Also


References

  1. Ganti, Latha, ed. Atlas of emergency medicine procedures. Springer Nature, 2022.
  2. Boyd, Anne S., Holly J. Benjamin, and Chad Asplund. "Splints and casts: indications and methods." American family physician 80.5 (2009): 491-499.
  3. Carruthers, Katherine H., et al. "Casting and splinting management for hand injuries in the in-season contact sport athlete." Sports Health 9.4 (2017): 364-371.
Created by:
John Kiel on 17 July 2023 21:12:17
Authors:
Last edited:
31 July 2023 15:06:44
Category: