Ulnar Gutter Splinting

Updated: May 03, 2017
  • Author: Dinesh Patel, MD, FACS; Chief Editor: Erik D Schraga, MD  more...
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Overview

Background

Splints are generally applied to decrease movement so as to provide support and comfort through stabilization of an injury. The primary purpose of a splint is to serve as a temporary bridge for nonemergency injuries to bones until definitive casting can be performed by a consultant, such as an orthopedic surgeon. Splints can also serve as initial immobilization in the preoperative period or as immobilization for primary healing. [1, 2]

All patients with injuries that are splinted should be referred for evaluation by a consultant in a timely fashion, usually within 2-3 days.

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Indications

An ulnar gutter splint (see the image below) can be used for various injuries to the upper extremities, including the following:

  • Soft-tissue hand injuries to the fourth and fifth fingers
  • Fourth and fifth metacarpal fractures [3]
  • Fractures of the fourth and fifth phalanges
  • Positioning for rheumatoid arthritis or osteoarthritis [4]
Ulnar gutter splint. Image courtesy of Kenneth R C Ulnar gutter splint. Image courtesy of Kenneth R Chuang, MD.
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Contraindications

Although no true contraindications for the placement of a splint are recognized, certain injuries require immediate evaluation or intervention by a consultant (eg, an orthopedic surgeon, hand surgeon, or plastic surgeon) and therefore may not necessitate splinting. Such injuries include the following:

  • Complicated fractures
  • Open fractures
  • Injuries with associated neurovascular compromise
  • Metacarpal angulation - In an otherwise uncomplicated metacarpal fracture, 10° of angulation is acceptable in the second and third metacarpals, 20° in the fourth, and 30° in the fifth; greater angulation often necessitates surgery, and such injuries require immediate evaluation or intervention by a consultant
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