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Ulnar gutter splint

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Edited by Grace Xiong, Harry Lightsey, Brendan Striano - 7/1/2021

Indications/Contraindications

Indications:

Fourth and fifth metacarpal and proximal phalanx fractures

Materials/positioning

Materials:

  • 4” plaster, 3 rolls
  • 4” ACE wraps, 4 rolls
  • 4” Webril, 4 rolls
  • Tape

splint-ulnargutter_materials

Positioning:

Usually in a stretcher with the patient sitting upright

Technique

Measure out splint:

On the uninjured side, measure the length of the splint using plaster from just distal to the ring finger DIP joint proximally to the mid forearm

Splint preparation:

  • 10-12 layers of plaster and 5 layers of webril
  • Cut the splint longitudinally along the midline to the approximate length of the fingers

splint-ulnargutter_webril

Splint application

  • Support the forearm and hand
  • Place the distal extent of the splint first such that it extends slightly past the ring finger DIP joint and position the remainder of the splint along the ulnar aspect of the hand and forearm

splint-ulnargutter_webril2

Molding in intrinsic plus position

  • Most fourth and fifth metacarpal and proximal phalanx fractures are stable in intrinsic plus position to the offset the action of the intrinsic muscles
  • Molding in this position entails flexion at the MCP joints and extension at the PIP joints

splint-ulnargutter_intrinsic

splint-ulnargutter_complete+ACE

Pearls & Pitfalls

Potential complications:

Be mindful of splint tightness, particularly around the fingers

Tips for efficiency: