Radial Gutter Splinting Periprocedural Care

Updated: Jul 05, 2016
  • Author: Lynne McCullough, MD, FACEP; Chief Editor: Erik D Schraga, MD  more...
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Periprocedural Care

Equipment

Equipment used in radial gutter splinting includes the following (see the image below):

  • Stockinette
  • Padding (eg, Webril)
  • Ready-made fiberglass (eg, Orthoglass) or plaster splinting material (eg, plaster of Paris), eight to 10 sheets, 3-4 in. wide
  • Bandage or wrap (eg, Bias bandage or Ace wrap), 2-3 in. wide
  • Clean room-temperature water in a basin
  • Trauma shears or a pair of medical scissors without pointed ends
  • Chucks pads and bed sheet
  • Tape (if using Bias bandage) or bandage clips (if using non-Velcro Ace wrap)
Equipment for radial gutter splint. Image courtesy Equipment for radial gutter splint. Image courtesy of Kenneth R Chuang, MD.

For injuries or reductions that require shorter drying times, faster-setting plaster is available (eg, Specialist Extra Fast Setting Plaster, which sets in 2-4 minutes). However, because the plaster dries faster, the risk of thermal injury increases. For most splints, regular plaster (eg, Specialist Fast Setting Plaster, which sets in 5-8 minutes) is appropriate.

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Patient Preparation

Anesthesia

Radial gutter splinting is usually tolerated without the use of anesthesia. However, if significant manipulation or reduction of the injury is required during the splinting process, anesthetic techniques may be used. Acceptable techniques include the following:

With the administration of any analgesic agent or the initiation of a formal sedation protocol, care should be taken to avoid oversedation. A complete neurovascular examination should be performed after the splint has been applied.

Positioning

Place the patient in a comfortable position (eg, seated or reclined). Cover the patient with a sheet to avoid splatter from the wet plaster (see the video below).

Radial gutter splinting. Cover patient appropriately. Video courtesy of Kenneth R Chuang, MD.

Completely expose the injured limb. Remove clothing on the proximal extremity, or warn the patient that it may have to be removed with scissors after the splint is placed. Remove the patient’s jewelry. In particular, rings can cause constriction and ischemia of the fingers with delayed swelling of the soft tissues. If unable to remove a ring, try using soap as a lubricant or consider a ring cutter. (See the video below.)

Radial gutter splinting. Remove jewelry and rings to avoid ischemia from swelling. Video courtesy of Kenneth R Chuang, MD.

To assist in achieving neutral position of the hand and wrist, some physicians advocate having the patient hold a can or a bandage wrap. Alternatively, the patient can imagine holding a wine glass. With either method, maintain the wrist at 15-25° extension.

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