The wide variety of designs for dorsal hand burn splints

The Role of the Fifth Metacarpophalangeal Joint in the Recovery of the Burnt Hand - is it Great or Small?

Clinical observation has shown that despite complying with text book regimes of exercises and splinting the outcome for some patients with partial thickness burns is extension contracture of the Fifth Metacarpophalangeal Joint (5th MCP joint).

This observation led to a review of the architecture and biomechanics of the hand in order to consider what could improve hand function following recovery of a thermal injury.

This paper reviews the architecture and biomechanics of the burnt hand and suggests that in the short term, the 5th MCP joint plays a central role in returning the hand to maximum function.

With this in mind a modified form of treatment has been adopted focusing attention on the 5th MCP joint and related structures.

Treating burn-associated joint contracture: results of an inpatient rehabilitation stretching protocol

The prevention and treatment of scar contracture is critical after significant burn injuries to avoid functional impairment. However, descriptions of specific contracture treatment interventions and outcomes are limited. Our objective is to provide detailed information and range of motion outcomes regarding the use of an intensive stretching protocol for burn-associated contracture. As part of a quality improvement measure, all patients admitted to inpatient rehabilitation with burn injury were treated with at least 1 hour of daily stretching by experienced therapists and were tracked with standardized range of motion measurements. Eighty-eight joint contractures were treated across nine patients for up to 4 weeks. The average weekly improvement in range of motion was 8.2 degrees (95% confidence interval [CI], 6.5-9.9). The largest gains were seen in the first week of treatment with an average improvement of 11.2 degrees (95% CI, 8.7-13.6). Eighteen digit contractures were treated across four patients. The average weekly improvement in flexion was 7.2 mm (95% CI, 5.2-9.1) again with larger gains in the first week of treatment-12.8 mm (95% CI, 10.3-15.4). Thumb opposition improved across five patients in the first week with an average improvement of 1.4 on the opposition scale (95% CI, 0.4-2.5). Intensive stretching by experienced therapists yielded significant improvements in joint range of motion for patients with burn-associated joint contracture. Defining specific burn contracture interventions remains a key goal in advancing burn rehabilitation in the future.

Rehabilitation of the burned hand

Successful outcomes following hand burn injury require an understanding of the rehabilitation needs of the patient. Rehabilitation of hand burns begins on admission, and each patient requires a specific plan for range of motion and/or immobilization, functional activities, and modalities. The rehabilitation care plan typically evolves during the acute care period and during the months following injury.

Splinting strategies and controversies

Splinting is a common burn care intervention strategy based on logical anatomic and biomechanical principles. The persistence of scar contraction requires countermeasures, frequently splints, and most clinicians would concur that splints are valuable in opposing these contraction forces. Clinical decisions about splinting are often made on respected opinion, leading mainly to design and application options. Variables that affect splinting strategy include the risk-to-benefit ratio of the splint, the timing of the application, the choice of splint design, and duration of the splinting intervention. The most common of these variables reported in the literature is simply unique designs for splints. Although there are different splint designs for similar problems, no data exist to favor one design over another. Controversy about splinting in burn care is not based on the rationale for and success of splinting but exists because of the paucity of validation of its use.