How do you splint 2nd or 3rd metacarpal fractures? A short arm volar splint is usually applied, because a fracture should be immobilized one joint distal and proximal to the injury. This splint, however, unnecessarily immobilizes the 4th and 5th fingers. It makes gripping things with your hand difficult.

Trick of the Trade: Radial Gutter Splint

This splint is the equivalent of the ulnar gutter splint, except that is placed along the radial aspect of the wrist and “sandwiches” the 2nd and 3rd fingers. The radial gutter splint provides both volar and dorsal splint immobilization of these metacarpal injuries.

  1. Cut out a 3- or 4-inch splint material to the length necessary to immobilize the wrist and MCP joint.
  2. Bisect the splint longitudinally from the fingertips to the wrist.
  3. Insert a dry gauze or cotton material between the 2nd and 3rd fingers.
  4. Fold the splint “tails” so that it sandwiches the volar and dorsal aspects of the 2nd and 3rd metacarpal.
  5. Secure the splint in place using bias wrap or an ace wrap.

The radial gutter splint provides optimal immobilization of the 2nd and 3rd metacarpals, while allowing for maximal mobility of the unaffected digits.

Michelle Lin, MD
ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco
Michelle Lin, MD


Professor of Emerg Med at UCSF-Zuckerberg SF General. ALiEM Founder @aliemteam #PostitPearls at Bio:
Michelle Lin, MD