What types of injuries are radial and ulnar gutter splints used for?

Radial and Ulnar Gutter Splint Indications

Radial gutter splints are used for fractures of the 2nd and 3rd metacarpals, while ulnar gutter splints are used for fractures of the 4th and 5th metacarpals.

Radial Gutter Splint

Primary Indications

• Non-displaced or minimally displaced fractures of the 2nd and 3rd metacarpals 1
• Radial-sided metacarpal injuries where immobilization of the fracture site is needed while allowing finger motion to prevent stiffness 1

Application Principles

• The splint must immobilize the fracture site while permitting active finger motion exercises, which should begin immediately following diagnosis to prevent stiffness—one of the most functionally disabling complications 1
• Finger motion does not adversely affect adequately stabilized metacarpal fractures 1
• Standard 3-view radiographic examination should confirm proper alignment before and after splint application 1

Treatment Duration and Follow-up

• Radiographic follow-up at approximately 3 weeks to confirm adequate healing 1
• For fractures with significant displacement (>3mm), dorsal tilt (>10°), or intra-articular involvement, surgical management may be indicated instead 1

Ulnar Gutter Splint

Primary Indications

• Fractures of the 4th and 5th metacarpals (boxer's fractures and similar injuries)
• Ulnar-sided hand fractures requiring immobilization

Key Distinction from Other Forearm Injuries

It's important to note that isolated midshaft ulna (nightstick) fractures are NOT treated with gutter splints—these diaphyseal fractures require either long-arm immobilization or surgical fixation depending on displacement and angulation 2

Common Pitfalls to Avoid

• Do not use gutter splints for distal radius or ulna fractures—these require sugar-tong splints or short-arm casts 2, 3
• Avoid excessive immobilization—prolonged splinting can lead to joint stiffness, muscle atrophy, and complex regional pain syndrome 4
• Never apply circumferential casts acutely—splints are preferred initially as they accommodate swelling, making them ideal for acute fractures 4