Introduction
The human hand is a versatile structure. It comprises many small bones and associated joints, making it quite flexible to carry out high-level functions. Therefore, utmost care needs to be given to maintaining the health of the hand.
Hands are vulnerable to injuries. When the hands get hurt, even simple tasks like holding an object become painful and difficult. Fractures and sprains are the most common injuries to the hand. Others include infections, inflammations, and lacerations of the joints, muscles, ligaments, and tendons of the hand.
What Is Ulnar Gutter Splint?
A splint is a rigid appliance devised to support and protect the injured area of the body. They work by eliminating the movement of the body part and pave the way for natural healing to take place. An elastic wrap or bandage is used to secure the splints.
The ulnar gutter splint or cast is classified under the hand and finger splints. They extend from the distal-most joint (near the fingertip) of the little and ring fingers, pass through the palm, and cover the two-thirds length of the forearm. As this splint is used for finger fractures commonly occurring in boxers, it is also called the ulnar gutter boxer splint. Doctors recommend purchasing an ulnar gutter splint for the injured area of the hands.
What Are the Indications of an Ulnar Gutter Splint?
The indications are as follows:
-
Fracture in the bones of little and ring fingers.
-
Joint injury between the palm and the last two fingers.
-
Soft tissue injuries related to the fourth and fifth fingers.
-
During the healing period of arthritis (inflammation of the joint).
What Are the Contra-Indications of an Ulnar Gutter Splint?
The indications are as follows:
-
In conditions where muscles and nerves are deprived of blood supply.
-
If there is a need for open surgery to realign the bone.
-
Open wound with a high risk of infection.
-
Complicated fractures where vital structures are involved and the bone is shattered into many small fragments.
How Is Ulnar Gutter Splinting Done?
Ulnar gutter splinting is done by a healthcare professional. For the convenience of splinting, the patients are placed in a supine (lying flat - facing upwards) position with the elbows bent. Anesthesia can be preferred according to the patient's pain perception.
-
Soft knitted fabric is used to cover the entire area. Initially, a small piece of it is placed between the little and ring fingers to absorb the sweat or moisture, preventing skin maceration. Next, the fabric covers both the fingers and finally extends through the palm beyond the mid-forearm. This process is called padding. The fabric around the fingers is intact, and they are slit beyond that, leaving the thumb, middle, and index fingers undisturbed. The edges are trimmed to avoid pressure on the skin.
-
The splinting material can be made of fiberglass or plaster. They are available at various inches of thickness. The desired length of the material is cut, usually shorter than the area covered by padding. The splitting material is applied over the borders of the little finger, wrist, and forearm. If the splitting material has plaster of Paris, they are immersed in warm water, squeezed, and then placed.
-
Finally, the elastic roll or bandage is wrapped around the splinting material overlapping each revolution, and allowed to dry out.
-
The complete splint is molded using the palm, and the extra materials are trimmed off.
-
The tips of the secured fingers are kept uncovered to check for the neurovascular status.
-
The ulnar gutter splint is secured in a slab position such that the joint between the palm and the last two fingers (metacarpophalangeal joint) is kept bent at an angle of 70 degrees, the proximal finger joint (away from the fingertip, and the distal finger joint (near the fingertip) at kept at an angle less than 10 degrees.
-
When the fingers are left in a straight position, the ligaments in the finger joints are relaxed, and over a period, the ligaments get tightened and make it difficult to move the joints. Hence the fingers are kept in a flexed position such that the ligaments are stretched to prevent shortening during immobilization.
Maintenance:
-
Patients are advised to keep the splint clean and dry.
-
They should not scratch the skin underneath the splint to avoid pressure injuries.
-
By resting, cold compressing with ice packs, and keeping the injured area in an elevated position, the healing time can be reduced.
-
Any abnormality like altered sensation in the fingers, pale skin, and severe pain should be addressed immediately.
-
Adhering to appropriate follow-up appointments at the specified date is necessary to prevent complications. Ideally, the splinting is rechecked after 48 hours and then once a week. A patient usually requires two to six weeks of complete immobilization of the injured area.
What Are the Uses of Ulnar Gutter Splint?
The purpose of the ulnar gutter splint is to support the ring and the little finger in the following ways:
-
Immobilizing the fingers.
-
Prevent or reduce muscle spasms and cramps.
-
Increase the strength of the injured area.
-
Repair and rectify minor deformities.
-
Stabilize the joints.
-
Prevents further damage.
What Are the Risks Associated With Ulnar Gutter Splint?
The following are the complications of ulnar gutter splints,
-
Persisting pain and swelling if the padding or wrapping is too tight.
-
Fabric creases and extra padding can induce pressure sores.
-
Irritation or burns caused during the setting of plaster of Paris (POP).
-
Damage to the nerve or blood vessels.
-
Decreased mobility of the joints after removal of the splints that may require physical therapy.
Splints and casts can give adequate immobility and sufficient period for the fracture to heal completely, but the major drawback is the eventuality of stiffness, continuous long-term pain, and muscle wasting. Therefore splints are reserved only for complicated fracture management that demands immobilization for a short period.
What Are the Drawbacks of Ulnar Shortening?
-
Neurovascular injury.
-
Secondary surgical procedures due to an irritation from the plate.
-
High risk of distal radioulnar joint osteoarthritis.
Conclusion
The ulnar gutter splint can be an effective supporting device if the proper technique of splinting is followed. At the same time, patient compliance and follow-up observations improve the treatment outcome. Patients must be aware of the treatment strategy, home care regimen, and complications related to ulnar gutter splint. With enhanced care and coordination, splinting can restore the complete range of motion in the joints.
Proper case selection, accurate splinting technique, well-trained professionals, and an efficiently organized follow-up will provide a high success rate of treatment outcome.
