11/28/2016

Why do burn patients need Splinting?

OP IN BURN
Splinting and Orthotics

Purpose of Splinting
► Protect fragile wound or newly grafted wound
► Position joints to maintain or achieved ROM SPLINTING
► Apply prolonged stretch to increase ROM Pre-
Pre-Fabricated Splints
► Maintain a position of choice by immobilizing
the joint (static splint)
► Exercise or mobilize a joint (dynamic splint)
► Apply pressure over a scar

Indications of Contraindications of
Pre-
Pre-fabricated Splints Pre-
Pre-fabricated Splints
► Need for positioning specific joints ► Direct application into fragile tissue
► Wound or Scar contraction ► Constrictive fixation strapping or wraps
► Decreased joint range of motion
► Need for safeguarding anatomical structures
► Need for conforming scar tissue
► Uncommunicative & unresponsive patient

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Advantages of Disadvantages of
Pre-
Pre-fabricated Splints Pre-
Pre-fabricated Splints
► Maintains or Increase (serial or dynamic) ► Potentialfor skin breakdown
joint position ► Shearing may occur if not properly fit or
► Can be used during any phase of healing fixed over a joint
► Custom formed for each individual ► May be difficult for nontherapist to apply
► Adjustable
► May protect exposed tissues

Consequences of Neck Burn

► Neck Flexion
contracture
► Facial Disfiguration
NECK BURN & SPLINTS ► Loss of Cosmetic
Contours of the neck
► Difficulty with
Mastication

NECK BRACES
Soft Cervical Collars
> For wounds that do
not involved the chin AXILLA & SHOULDER
> Provides positioning,
pressure and contour BURNS AND SPLINTS
Philadelphia collars
> Extends at the chin for
increased moment arm
resistance

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Consequences of Axilla & Shoulder Burn AXILLARY SPLINT

► May lead to adduction AIRPLANE SPLINTS
contracture and
webbing of axillary fold ►Reduces the
► Contributes to difficulty likelihood of
in reaching and developing axillary
overhead use of the
contracture during
arm
burn healing

Consequences of Elbow &

Forearm Burn
Most Common
ELBOW & FOREARM Contracture
BURNS AND SPLINTS ► Elbow flexion
contracture
► Pronation
contracture

Elbow & Forearm Splints

► This should fit the arm
from the proximal third WRIST & HAND
of the brachium to the
distal 3rd of the BURNS AND SPLINTS
forearm
► Fixed by straps or
circular gauze or
elastic wrapping to the
elbow & forearm

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Consequences of Wrist & Hand Burn WRIST AND HAND SPLINT

► May lead to
contractures in ANTIDEFORMITY
extension or flexion or SPLINTS
ulnar or radial
deviation depending
► PLACEHAND IN
on the location of the
burn. FUNCTIONAL
POSITION
► Affects the web space
of the thumb

WRIST AND HAND SPLINT

PAN SPLINT
► POSITIONS ALL TRUNK & PELVIS
FINGERS IN
EXTENSION BURNS AND SPLINTS
► THIS IS A
MODIFICATION OF
ANTIDEFORMITY
SPLINTS

Consequences of Burn at the

TRUNK SPLINTS
Trunk & Pelvis
CLAVICULAR STRAPS
► Positions the shoulder
in retraction and
counteract the flexion
forces in healing upper
► Trunk burns are at risk of developing kyphosis trunk burns.
► For burns of the pelvis, groin and hip, the problem
is the likelihood of hip flexion and adduction
contractures.

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PELVIC SPLINTS
HIP ABDUCTION SPLINTS
► Necessary for patients LOWER EXTREMITY
with healing burns at
the hip, groin and BURNS AND SPLINTS
pelvis.
► Counteracts Hip flexion
and Adduction
Contracture

Consequences of LE Burn LOWER EXTREMITY SPLINTS

► Knee burns may lead to flexion contracture KNEE
► The location of burns at the ankle and foot ► THREE POINT KNEE EXTENSION
dictates whether the patient is at risk for ► AIR SPLINT
plantar flexion or dorsiflexion contracture FOOT & ANKLE
► POSTERIOR FOOT DROP SPLINTS
► POSTERIOR OR ANTERIOR ANKLE
CONFORMERS
► BUNNY BOOTS

KNEE SPLINTS ANKLE SPLINTS

AIR SPLINT POSTERIO FOOT
► Reduces the risk of DROP SPLINTS
flexion contracture ►Minimizes
as the burn scar
plantarflexion
matures
contracture

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ANKLE SPLINTS
BUNNY BOOTS
►For positioning FACE & MOUTH
ankles that have BURNS AND SPLINTS
been burned
►Reduces ankle
contracture
during scar
maturation

Consequences of Face & Mouth Burn FACE & MOUTH SPLINTS

► Burns of the face can MICROSTOMIA
affect the eyes & PREVENTION SPLINTS
► Apply stretch to
eyelids, contours of he
Commissures and Fibrotic
face, and the soft Oral Muscles
tissue around the ► Worn at all times when the
mouth patient is not eating or
(MICROSTOMIA) receiving oral care or
speaking.
► Microstomia interferes
with feeding, speaking
& dental care

FACE & MOUTH SPLINTS ADDITIONAL CONSIDERATIONS

BURN MASKS ► Elastic wraps & Dynamic Splints
► DECREASE SCAR Increase ROM
HYPERTROPHY & Act as Temporary Splints
MINIMIZE OR
PREVENT ECTROPION ► Plaster
Casts, Thermolastic Materials,
(EVERSION) Dynasplints
DEFORMITY OF THE For serial splinting protocol
LOWER EYELIDS & For patients with EXISTING CONTRACTURES
THE LIPS
Assist in stretching the deformity

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SPECIAL REHABILITATIVE SPECIAL REHABILITATIVE

COMPLICATIONS COMPLICATIONS cont…
►PERIPHERAL
NEUROPATHY WITH
Occurs in patients with Deep Thermal MOTOR OR SENSORY DEFICIT
Burns or Electrical Injury Idiopathic Neuropathy occurs most often
Most common complications: in patients with 20% TBSA
►EXPOSED TENDON Secondary Neuropathy may be caused by
Should be kept moist with an Ointment based overelongation or compression of a
Gauze or Biological Dressing peripheral nerve
Limb is splinted in a position where the tendon is
slack & EXERCISE AVOIDED

THE END
THANK YOU!