121 25 years later: Has the Practice of Splinting Burned Joints Changed?

Abstract

Abstract Introduction Burn scar contracture (BSC) across joints is a common pathological outcome following burn injuries, leading to limitations in range of motion (ROM) of affected joints and impairment in activities of daily living (ADLs). Despite a paucity of research addressing it efficacy, static splinting of burned joints is a common preventative practice. A survey of burn centers performed 25 years ago showed a widely divergent practice of splinting. We undertook this study to determine the current practice of splinting in acute burn injuries. Methods This is a retrospective observational study of 246 patients who were included in the Burn Patient Acuity Demographics, Scar Contractures and Rehabilitation Treatment Related to Patient Outcome Study (ACT) database from 2010–2013. The most commonly splinted joints (elbow, wrist, knee and ankle) and their 8 motions were included. Variables included patients’ demographics, burn variables, rehabilitation treatment and hospital course details. Univariate and multivariate analysis of factors related to splinting was performed. P< 0.05 was significant. Results Thirty percent of the study population (75 patients) underwent splinting during their hospitalization. On average splinting was initiated about a third of the way into the hospital length of stay (LOS, 35 ± 21% of LOS) and splints were worn for 50% (50±26%) of the LOS. Joints were splinted for an average 15.1 ± 4.8 hours a day. Joints with higher amounts of burn involvement and need for grafting to their associated cutaneous functional units (CFU) were more likely to be splinted (p< 0.001). The wrist was most frequently splinted (30.7%) while the knee was the least frequently splinted joint (8.2%). The knee was splinted the longest (17.6 ± 4.8 hours) and the ankle the least (14.4 ± 4.6 hours). One third had splinting continued to discharge (20, 27%). The requirement for skin grafting in the associated CFU was the only factor that was independently related to splinting, increasing the odds of splinting 2% for every 1% of CFU grafted (adj OR =1.02, 95% CI=1.01–1.03, p< 0.001). Conclusions The current practice, especially the timing, hours of wear and duration of splinting following burns remains diverse among burn centers. Splinting is more common in joints that have more burn and deeper burns require grafting in the associated CFU; otherwise there appears to be little consensus in the practice of splinting. Future study looking at splinting application and its outcomes is warranted.