Ulnar Gutter Splint

Other Names

Illustration of the ulnar gutter splint

Ulnar gutter splint mid procedure with demonstration of the splinting material

Finished ulnar gutter splint

• Ulnar Gutter Splint

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Background

• This page reviews the ulnar gutter splint
• Limits flexion/extension of the 4th/5th DIP, PIP, MCP, and wrist joints

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Indications

• Boxers Fracture
  • When compared to functional metacarpal splint (FMS), the FMS yielded similar long term outcomes ulnar gutter splint
• 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
• Soft tissue injuries in the same distribution
• Nondisplaced Distal Ulna Fracture

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Contraindications

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

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Procedure

Equipment

• See: Splinting Materials

Preperation

• Measure splint material
  • Measure from the DIP joint of the 4th and 5th digit to mid-forearm along ulnar surface
  • You will need 8-10 layers

Technique

• Patient position
  • Metacarpophalangeal (MCP) joints of the 4th and 5th finger at 70 to 90° flexion,
  • Proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints in slight flexion
  • Wrist in extension at 10 to 20°.
• Stockinette
  • Should cover mid-forearm to the 4th and 5th fingertips
• Web roll/ cast padding
  • Insert padding between the 4th and 5th fingers
  • Wrap padding from the MCP joint to the mid-forearm slightly beyond the area to be covered by the splint material
  • Overlap each turn by half the width of the padding
  • Smooth the padding as necessary
  • Tear any areas of excess padding to prevent areas of increased pressure on the skin.
• Splinting material
  • Immerse splinting material in lukewarm water, squeeze out excess water
  • Apply the splint material along the ulnar side of the 5th finger, wrist, and forearm
  • Fold it in a U-shape around the dorsal and volar surfaces of the 4th and 5th fingers, hand, and wrist.
• Fold the extra stockinette and cotton padding over the edges of the splinting material.
• Wrap the elastic wrap over the splinting material distally to proximally
  • Overlap each revolution by half the width of the elastic wrap
• Smooth out the splinting material
  • Use your palms rather than your fingertips to conform to the contour of the arms
• Confirm the distal neurovascular status

Pearls and Pitfalls

• Do not immobilize the thumb, index finger, or middle finger in the splint

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Aftercare

• 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

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Complications

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

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See Also

• Procedures Main
• Splinting Main

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