eMedicine Specialties > Clinical Procedures > Musculoskeletal Procedures
Splinting, Ulnar Gutter
Updated: May 15, 2009
Introduction
Splints are generally applied to decrease movement to provide support and comfort through stabilization of an injury. The primary purpose of a splint is as a temporary bridge for nonemergent 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 presurgical period or as immobilization for primary healing.1 All patients with injuries that are splinted should be referred for evaluation by a consultant in a timely fashion, usually within 2-3 days.
Indications
An ulnar gutter splint 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
- Fractures of the fourth and fifth phalanges
- Positioning for rheumatoid arthritis
Contraindications
Although no true contraindications exist to the placement of a splint, certain injuries require immediate evaluation or intervention by a consultant (eg, orthopedic surgeon, hand surgeon, plastic surgeon) and, as such, 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 are acceptable in the second and third metacarpal, 20° in the fourth metacarpal, and 30° in the fifth metacarpal. Greater angulation often requires surgery; such injuries need the immediate evaluation or intervention of a consultant.)
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References
Howes DS, Kaufman JJ. Plaster splints: techniques and indications. Am Fam Physician. Sep 1984;30(3):215-21. [Medline].
Sacchetti A, Senula G, Strickland J, Dubin R. Procedural sedation in the community emergency department: initial results of the ProSCED registry. Acad Emerg Med. Jan 2007;14(1):41-6. [Medline].
Kaplan SS. Burns following application of plaster splint dressings. Report of two cases. J Bone Joint Surg Am. Apr 1981;63(4):670-2. [Medline].
Halanski MA, Halanski AD, Oza A, Vanderby R, Munoz A, Noonan KJ. Thermal injury with contemporary cast-application techniques and methods to circumvent morbidity. J Bone Joint Surg Am. Nov 2007;89(11):2369-77. [Medline].
Chudnofsky C, Byers S. Splinting techniques. In: Roberts J, Hedges J. Clinical Procedures in Emergency Medicine. 4th. Philadelphia: W.B. Saunders Company; 2004:989.
Menkes J. Initial evaluation and management of orthopedic injuries. In: Tintinalli J, Kelen G, Stapczynski J. Emergency Medicine: A Comprehensive Study Guide. 6th. New York: McGraw-Hill; 2003:1651.
Keywords
ulnar gutter, metacarpal fracture, splinting, splint, splints, finger fracture, phalanges fracture, rheumatoid arthritis, hematoma block, nerve block, ace wrap, elastic bandage, plaster, thermal injury, thermal burn, pressure sore, contact dermatitis, finger swelling, range of motion, ROM, degree of angulation
