Cut out a 3 or 4 inch splint material to the length necessary to immobilize the wrist and mcp joint.
Gutter splint mcp.
Bisect the splint longitudinally from the fingertips to the wrist.
The radial gutter splint provides both volar and dorsal splint immobilization of these metacarpal injuries.
Radial gutter splint cast second and third proximal middle phalangeal shaft fractures and select metacarpal fractures proper positioning of mcp joints at 70 to 90 degrees of flexion pip and dip.
If there is a pip flexion contracture a prefabricated dynamic three point extension splint might be used or a static splint can be adjusted serially with the goal of achieving full passive pip.
A blinded randomized trial.
Pip joints in 5 10 degrees flexion.
Leave the thumb index and middle fingers freely mobile.
Dip joints in 5 10 degrees flexion.
Splinting mcp s in flexion and ip s extended intrinsic plus positioning safe position forearm based or hand based gutter splint position of mcp joints collateral ligament stablility.
Mcp joints in 70 90 degrees flexion.
Insert a dry gauze or cotton material between the 2nd and 3rd fingers.
The goal of splinting for boutonniere deformity is to maintain pip joint extension while keeping the mcp and dip joints free for about 6 to 8 weeks.
Wrist in slight extension.