Is an ulnar gutter splint used for a boxer's fracture?

From the Guidelines

An ulnar gutter splint is the recommended immobilization method for a boxer's fracture, as it effectively immobilizes the wrist and the 4th and 5th metacarpals while allowing functional use of the thumb, index, and middle fingers. When applying the splint, it is essential to position the wrist in slight extension, the metacarpophalangeal (MCP) joints flexed, and the interphalangeal (IP) joints in slight flexion, as this positioning helps prevent complications such as shortening or rotational deformities that could lead to decreased grip strength or finger overlap 1. The splint should extend from the mid-forearm to just beyond the fingertips of the ring and little fingers. Although there is a lack of evidence demonstrating clear benefits from fracture splinting in the prehospital first aid setting, fracture immobilization is an essential part of definitive fracture treatment, and splinting as a first aid measure may be helpful to reduce pain, prevent further injury, and facilitate transport 1.

Key considerations for the application and management of an ulnar gutter splint include:

• Immobilizing the injured extremity in the position found, as this is accepted first aid practice 1
• Reducing angulated fractures may reduce pain and improve transport, but this should be done with caution and ideally by a professional 1
• Monitoring for signs of poor perfusion, such as blue, purple, or pale extremities, which may indicate a limb-threatening injury requiring immediate professional medical care 1
• Keeping the splint in place for the recommended duration, typically 3-4 weeks for uncomplicated fractures, with follow-up X-rays to ensure proper healing.

It is crucial to prioritize proper immobilization and seek professional medical care to ensure the best outcomes in terms of morbidity, mortality, and quality of life for patients with a boxer's fracture.

From the Research

Ulnar Gutter Splint for Boxer's Fracture

• The ulnar gutter splint is a simple and proven method for immobilizing boxer's fractures, as stated in the study by 2.
• Boxer's fracture is a common name for a fracture of the distal fifth metacarpal, and the ulnar gutter splint is one of the methods used for its treatment, as mentioned in the study by 3.
• A study by 4 compared conservative treatment using an ulnar gutter slab with transverse pinning in fifth metacarpal neck fractures in active adults, and found that both methods were effective in treating simple extra-articular fifth metacarpal neck fractures with angulation between 30 and 70 degrees.
• Another study by 5 described a method of achieving and maintaining reduction of a boxer's fracture using a plaster splint, which can be implemented during drying of the plaster splint, and adequate roentgenograms can be taken without the presence of redundant plaster over the fracture site found with the traditional ulnar gutter splint.
• The use of ulnar gutter splints is also mentioned in the study by 6, which describes the fabrication of dynamic traction splints and alternative splint applications for the management of intra-articular fractures.

Effectiveness of Ulnar Gutter Splint

• The study by 2 suggests that the ulnar gutter splint is a proven method for immobilizing boxer's fractures.
• The study by 4 found that conservative management using an ulnar gutter slab was effective in treating simple extra-articular fifth metacarpal neck fractures with angulation between 30 and 70 degrees, with results comparable to transverse pinning.
• The study by 5 describes a method of achieving and maintaining reduction of a boxer's fracture using a plaster splint, which can be an alternative to the traditional ulnar gutter splint.