97 Role of Early Splinting, Positioning, and Edema Control of Burn Effected Joints in the Prevention of Burn Scar Contracture

Abstract

Burns involving joints can lead to debilitating contractures that can impair a survivor’s reintegration back into the work force and overall quality of life. There is lack of evidence supporting the timing and effectiveness of standard prophylactic treatment including splinting, positioning and edema control. This study seeks to determine contributing factors of early BSC and the efficacy of acute standard prophylactic interventions. The records of 300 patients within the Burn Patient Acuity Demographics, Scar Contractures, and Rehabilitation Treatment Time Related to Patient Outcomes (ACT) study from 2010–2013 were reviewed. Data abstracted included demographics, burn data, daily rehab interventions and discharge joint measurements. BSC was classified as none, mild (<30%), moderate (30–60%), or severe (>60%) based on normal joint passive range of motion. Univariate analysis and multi logistic regression (MLR) was used to determine the effect of contributing factors and BSC prevention methods on the incidence of BSC at hospital discharge. 266 (86.7%) patients were found to have BSC in at least one joint prior to discharge. Of the 3,279 joints analyzed, 44% had loss of range of motion (100 mild, 99 moderate and 60 severe). The most affected joints and movements were ankle dorsiflexion (128, 79% with BSC) and wrist flexion (117, 62% with BSC). Factors related to BSC were TBSA, surgery, length of stay (LOS), ICU days, bedrest days, and escharotomy/fasciotomy. Treatment factors included average daily hours of splinting, positioning, edema control and rehab. Only amount of skin grafted remained independently related to moderate or severe contracture on multivariable analysis. BSC occurs in a significant number of survivors during the initial phase of their burn injury. As the need for surgery is related to BSC formation, therapists should focus on these patients. Future studies are needed to refine the timing and efficacy of standard treatment for BSC. Therapists should concentrate efforts on the most severely injured patients.