Cutaneous functional units prediction in outcomes of early and intensive splinting following palmar burn injury in young children: a prospective study

Abstract

BackgroundPalmar burn injuries are common in young children and can result in contracture. MethodsA prospective longitudinal study describes outcomes of palm and digit extension splint use following burn in 75 children (83 hands) aged < 5 years and determines whether specific cutaneous functional units (CFUs) are associated with early signs of contracture (ESC). Outcomes were assessed up to 9–18 months following burn. Routine clinical data was collected at therapy reviews. ResultsChildren were splinted > 12 h/day for a mean of 158 days following burn. The mean time to splint cessation was 264 days following burn. Fourteen hands developed ESC (17%): 12 hands had full ROM restored following conservative management, 2 hands (3%) progressed to contracture. Hands that developed ESC had greater healing time (p = 0.002), greater number of CFUs affected (p < 0.001), and greater number of immediate first webspace and extended first webspace CFUs affected (p = 0.002, p < 0.001 respectively). ESC risk increases for each day to heal (odds ratio [OR] 1.1, 95% CI 1.0–1.2) and each CFU in extended first webspace (OR 2.8, 95% CI 1.5–5.0). ConclusionEarly and intensive splinting following palmar burn results in excellent ROM. Burns involving more CFUs or the first webspace are associated with ESC.