Contracture and the role of splinting in contracture management in burn

In burned patients, Physical Medicine and Rehabilitation mission is to establish maximum function, reduce pain and prevent deformity and special attention to cosmetic issues. Orthoses is one of the most common treatment approaches in burn. Also, activity and therapeutic exercise are essential issues to prevent joint and skin contracture and preserving function, but splinting is optional. Orthoses in burn are mostly used in distal upper extremity, hand burn. Choice of splint depends on the site and the area of the burn, its depth and severity, burned tissues, edema, blister formation, infection and other secondary complications. When the patients are unable to participate in active rehabilitation, as comatose patient or the children, patients with deep dorsal hand burn with tendon and/or ligament exposure or burn, splinting is more effective. At early phases of burn (first two weeks) splinting for proper positioning and prevent skin and/or joint contracture are mostly prescribed. Splint may be used only at night or with intervals of activity and exercise. The Static splints mostly used in early phase of the burn while dynamics applied in late phase or post-surgical interventions. Prevention of hyperextension is necessary for burn with metacarpophalengeal (MP) involvement and splinting is an effective treatment. Low weight, proper appearance, easy cleaning, easy donning and doffing are the most characteristics of a burn splint. Some splints prescribed for burned patients are: Mallet finger splint, Boutonniere deformity splint, wrist cockup splint, Thumb opposition splint, MP flexion splint, Web space splint, Safe or intrinsic plus splint and Open Palm or Pancake splint.