What are splints?
An ulnar gutter splint is a flexible splint that is used to support, stabilize, and immobilize injuries, dislocations and fractures of the hands, fingers, or wrists.
Splints are usually applied to reduce movement and provide support and comfort by stabilizing an injury. They are primarily used during nonemergency injuries to the bones or ligaments until they can be evaluated by a consultant such as an orthopedic surgeon. They are also used to temporarily immobilize an extremity before surgery (e.g., for an open fracture) or enable healing.
Unlike casts, splints are preferred in an emergency setting when the injuries are acute and swelling may continuously increase. All patients with splinted injuries should be referred for evaluation by a consultant within two to seven days.
How does an ulnar gutter splint work?
An ulnar gutter splint is a flexible splint that is used to support, stabilize, and immobilize injuries, dislocations and fractures of the hands, fingers, or wrists to allow the bones and tissues to heal properly.
What is an ulnar gutter splint used for?
An ulnar gutter splint can be used for various injuries in the hand including the following:
- Soft-tissue hand injuries to the little and ring fingers
- Fractures anywhere in the pinky and ring fingers
- Positioning and healing of rheumatoid arthritis or osteoarthritis
When is an ulnar gutter splint not done?
There are no absolute contraindications for ulnar gutter splinting. Relative contraindications involve the following injuries that require an immediate evaluation or intervention by a consultant (an orthopedic surgeon, a hand surgeon, or a plastic surgeon):
- Complicated fractures
- Open fractures
- Injuries with associated neurovascular compromise
How do you wrap an ulnar gutter splint?
Anesthesia
- Ulnar gutter splinting is usually tolerated without the use of anesthesia. In case of significant pain during joint manipulation or reduction of fracture, anesthesia and painkillers would be required.
- There are various types of ulnar gutter splints that are made of various materials and have different techniques of application. Ulnar gutter splints are generally applied by a healthcare professional.
The procedure
- The injured limb is completely exposed.
- A stockinette covering the pinky finger extends beyond the wrist till just before the elbow.
- Soft padding is applied over the stockinette. The padding should extend 2-3 cm beyond the overlying plaster on both ends.
- Plaster of Paris (POP) is applied over the padding. A bandage wrap is applied over the wet plaster.
- The thumb and wrist remain immobile until the splint is dry. The patient may feel some warmth released from the plaster as it dries.
- In case of a simple sprain, the doctor may advise a simple brace with Velcro clips or a bandage wrap to be worn for two to six weeks to immobilize the injured area.
Aftercare
- The patient is advised to rest, elevate and ice the injured limb. If the patient experiences weakness, numbness, color change (pale or bluish), increasing pressure or pain or spreading redness, it is advised to remove the splint and visit the emergency department right away.
- The splint must be kept clean and dry. Patients can be tempted to use sticks, pens, or hangers to scratch an itch inside the splint. Sticking objects into the splint to scratch yourself can wrinkle the padding and lead to pressure injuries or cause cuts in the skin and potentially an infection. The splint is usually rechecked in 48 hours by the doctor.
What are the complications of ulnar gutter splints?
Complications to ulnar gutter splints include the following:
- Thermal burns due to the warmth as the plaster dries
- Pressure sores
- Contact dermatitis
- Neurovascular compromise (damage to the nerves and blood vessels)
- Decreased range of motion from immobilization.
Hence, aftercare often requires physical therapy.