Introduction:
A splint is a rigid medical device. It is manipulated to immobilize and stabilize the realigned bone in a dislocated fracture sire. The splints enhance the primary healing of the injury. The splints are available in various forms that can fit any part of the body to serve its purpose. They are easy to handle and less time-consuming than other immobilization methods like casting. Hence, in recent times, splints have been more commonly preferred in casualty centers as an emergency tool to maintain the split bone in place until definitive treatment is planned.
What Is a Radial Gutter Splint?
The forearm of the upper limb consists of two long bones, namely the radius and the ulna. The ends of these bones meet up with the other tiny bones in the wrist and fingers, forming a significant unit. These joints, along with the ligaments and tendons, make the hand a versatile structure.
A radial gutter splint is a type of hand and finger splint. They are used to immobilize the fracture fragments in the index (second) and the middle (third) fingers. Since these fingers line along the side of the radius bone, the splint is called the radial gutter splint.
What Are the Indications of a Radial Gutter Splint?
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Fracture in the bones (phalanges) of the index and middle fingers.
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Fracture of the metacarpals (tubular bone in the palm area) in line with the index and the middle fingers.
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Soft tissue injuries related to the index and the middle fingers.
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Inflammatory changes in the joint.
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Tearing of joint capsules in or between the index and the middle fingers.
What Are the Contra-Indications of a Radial Gutter Splint?
The relative contraindication for radial gutter splint is,
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Open fractures where there is an increased risk of infection.
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Complicated fractures that demand immediate surgical intervention.
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Conditions where the nerves and blood vessels are damaged.
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Not indicated in angulated neck fractures of the second and third metacarpals.
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Significant bone deformities as seen in some skeletal birth defects.
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Severely displaced or rotated fractures of the index and the middle finger bones.
What Are the Procedures Involved in Radial Gutter Splinting?
The splinting is done in alignment with the radius bone. The procedure can be carried out with or without anesthesia depending on the extent of the injury and the patient's comfort. Generalized physical examination, basic blood work, and neurovascular evaluation should be done before starting the procedure.
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The patient is placed in a comfortable position and with easy access to manipulate the hand for splinting.
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The stockinette is a tubular elasticated cotton sleeve into which a limb is inserted. it is placed around the forearm beyond the mid-level, usually two to three centimeters extra than the desired level of splint application. The fabric is cut near the open ends only to cover the index and the middle finger. A small piece of gauze is placed between the two fingers to prevent maceration from moisture or sweat. Sufficient space should be given for the thumb finger to maintain the normal range of motion without any contraction. The ends are trimmed evenly to avoid excess loading.
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Now the splinting material, either plaster or fiberglass (readily available with the needed thickness), is cut to cover the length of the stockinette but a little shorter. They extend up to the covered fingers relieving the thumb.
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Then the splint is secured using a wrap of the elastic roll and allowed to set.
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The excess splinting material, stockinette, and elastic rolls are trimmed, and the tip of the fingers are left open to assess neurovascular status.
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Before the material sets, the ideal angulations of the joints are configured. It is suggested that the position of the metacarpophalangeal joints (where the fingers join the palm) be kept at 70 to 90 degrees flexed. The proximal and the distal interphalangeal joints (the PIP and DIP joints) are bent at 10 to 15 degrees. The wrist is kept in a functional position at 30 degree dorsiflexions (backward bending of the hand).
What Are the After-Care Procedures Post Radial Gutter Splinting?
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As in every case, the splint must be kept dry and clean.
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Avoid touching inside the cast or the splint to prevent scratch injuries.
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The healing phase can be promoted by the R.I.C.E (rest, ice, compression, and elevation) method.
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Increased pain, redness, abnormal sensation, pale skin, and any streaking should be reported immediately.
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A follow-up appointment must be fixed at 48 hours initially and continued weekly until they are removed.
What Are the Uses of Radial Gutter Splint?
The major purpose of the radial gutter splint is to support and stabilize the index and the middle finger by,
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Binding the fingers and disabling their actions for a few days.
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Protect the associated muscles and soft tissues.
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Provide sufficient healing time to the injured area without disturbing the other fingers.
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Minor deformities can be corrected.
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Fix and preserve the joints from further damage.
What Are the Drawbacks Associated With Radial Gutter Splint?
The following are the drawbacks that can occur with radial gutter splinting when the time, duration, proper procedure, and follow-ups are maintained appropriately.
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Skin lacerations.
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The pain and swelling may increase with tight padding. When swelling increases, remove the splint and apply the R.I.C.E method. Once the swelling subsides, retry splinting without applying much pressure.
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Sores or rashes will occur from stockinette creases or extra padding.
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Temperature-induced burns from the plaster of Paris. Sometimes, towels or blankets are wrapped over the splint for quick drying of the material, which may increase the heat produced, leading to thermal injuries.
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Stiffness of the joints when the MCP (metacarpophalangeal), DIP (distal interphalangeal), and PIP (proximal interphalangeal) joints are not positioned in the required angulation. Physical therapy can be given to attain the required flexibility.
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Compression of the nerves and blood vessels.
Conclusion:
The treatment with radial gutter splinting can be a very productive strategy when all the rules are followed precisely. But patient cooperation is important as well for the successful treatment outcome. Patients must also be alert to the risks associated with radial gutter splints. Though with all the hinges, the splinting procedure can enhance the treatment effect and restore the essential range of motion in the joints.
