Ulnar gutter splint

Background

• Limits flexion/extension of the 4th/5th DIP, PIP, MCP, and wrist joints

Indications

• Hand and finger fractures and soft tissue injuries of 4th and 5th digit
• Boxer's fracture

Procedure

Splint Application General Procedure

• Assess pre-procedure neurovascular status (i.e., distal pulse, motor, and sensation)
• Measure and prepare the splinting material
  • May use contralateral extremity if easier
  • Most splints use a width slightly greater than the diameter of the limb
• Apply stockinette (if applicable)
  • Extend 2" beyond estimated the splinting material length
• Apply padding (if applicable)
  • Use 2–3 layers over the area to be splinted / between digits (when applicable)
  • Add an extra 2–3 layers over bony prominences
• Apply splinting material
  • Lightly moisten the splinting material.
  • Place as appropriate to specific splint type
  • Once finished, if applicable fold the ends of stockinette back over the splinting material if there is excess
• Apply elastic bandaging (e.g., ace wrap)
• While still wet
  • May further mold the splint to the desired shape
  • Maintain position until splint material has hardened
• Re-check and document repeat neurovascular status

Splint-Specific Details

• Apply padding and splint material as shown in figure
  • Place padding between 4th and 5th digits to prevent maceration
• Splint course:
  • Start at mid-forearm
  • Extend down ulnar aspect of forearm
  • End at mid-distal phalanx
    • Include the 4th and 5th digits
• Key anatomic positions
  • Wrist slightly extended (10° to 20°)
  • 4th and 5th MCP at 50°
    • If Boxer's fracture, 90° flexion
  • DIP/PIP in slight flexion (~5–10º)
  • Hand in position of function
  • Forearm in neutral position

See Also

• Splinting