832 Trends for Treatment of Complex Hand Burns in the Acute Setting

Abstract

Abstract Introduction Complex hand burns require special consideration of therapy practices within the acute setting. Deep hand burns, their associated injuries, and the sequelae of healing can cause significant dysfunction. The purpose of this study was to examine current practices in the inpatient treatment of complex hand burns in order to identify potential trends that may guide clinical practice for edema management, anti-deformity positioning, and range of motion (ROM). Methods A confidential internet survey was sent to burn therapists in this country from the American Burn Association (ABA) Occupational and Physical Therapy (OT/PT) Special Interest Group list. One therapist from each burn center was asked to complete the survey. Results There were 41 respondents representing 33% of burn centers. The majority of respondents were occupational therapists (78%) from burn centers with 500 or less annual admissions (76%) and more than 16 years of experience treating burn patients (68%). Burn therapists most commonly measure composite (57%) and isolated (51%) joint passive/active ROM, followed by measuring distance from fingertip to distal palmar crease (43%). With questionable or confirmed tendon involvement, the majority (68%) of OT/PTs performed isolated joint techniques, with active ROM the most common at 38%. Therapists initiate edema management, other than elevation, within 24 hours (44%) from the patient’s admission. The most prevalent edema management practice is active exercise (94%) compared to other more aggressive practices such as self-adherent wrap (50%). Anti-deformity orthotics are initiated within 24 hours (44%) and are the most common means of post-graft immobilization (41%). For hand stiffness, 53% of therapists utilize casting. For stiff proximal interphalangeal (PIP) joints, joint mobilization (45%) and thermal modality with ROM exercises (32%) were viewed as the most effective interventions, surpassing orthotics and casting. While 88% of centers utilize an interdisciplinary approach to care for the hand, 59% view the hand as a surgical priority. Percutaneous pins are utilized for joint stability, most frequently in PIP joints (62%) and remained 2–3 weeks on average (45%). Conclusions The survey highlights trends directed towards a more conservative management of complex hand burns related to edema management, anti-deformity positioning, and ROM. There is less of a clear consensus among burn therapists on how to approach complicated hand injuries that involve exposed/injured tendons or stiff joints. Interdisciplinary rounds can be utilized to promote communication regarding more aggressive means of therapy intervention in order to improve patient outcomes related to the hand. Applicability of Research to Practice Present current trends in the inpatient treatment of complex hand burns.