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Ulnar Gutter Splint

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Other Names

Illustration of the ulnar gutter splint
Ulnar gutter splint mid procedure with demonstration of the splinting material[1]
Finished ulnar gutter splint[2]
  • Ulnar Gutter Splint


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



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




  • 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


  • 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


  • 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. Ganti, Latha, ed. Atlas of emergency medicine procedures. Springer Nature, 2022.
  2. 2.0 2.1 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.
Created by:
Jesse Fodero on 10 July 2019 17:26:41
Last edited:
22 June 2023 12:22:32