ORTHOSES FOR BURN

MANAGMENT

PRESENTED BY :
Aleena Noor
Zerfishan Iftikhar
Adeeba Tabbasum
 TABLE OF CONTENT
• Introduction to burn
• Burn Care 6 C s
• Splint Design
• Indications
• Positioning and Splinting
• Deformities
• Classification
• Types
 Introduction

• A burn is an injury to the skin or other organic

tissue primarily caused by heat or due to
radiation, radioactivity, electricity, friction, or
contact with chemicals
• Most burns are due to heat from hot liquids
(called scalding), solids, or fire.
• A splint is a rigid support made from metal,
plaster, or plastic. It's used to protect, support,
or immobilize an injured or inflamed part of
the body.
• The specific use of orthoses in burn
management can vary depending on the
severity and location of the burn, as well as
the individual's needs.
 6 Cs

• A systematic approach to burn care

focuses on the six “Cs”: clothing, cooling,
cleaning, chemoprophylaxis, covering and
comforting (i.e., pain relief).
 Splint design
• Should be kept simple so that a splint is easy
to apply, remove, and clean.
• Usually worn at night, when pt is resting, or
continuously for several days following skin
grafting.
• Splints should conform to the body parts, and
care must be taken to ensure that there are no
pressure points that may cause a breakdown
in healing or normal skin.
 Indication for Splint Use
Splints are generally used for:
• Prevention of contractures
• Protection of a joint or tendon
• Immobilization following a skin graft
• Decreased Range of Motion (ROM)
• Maintenance of ROM obtained while
exercising or during a surgical release
• Poor patient compliance
For patients with burns injury, splints are used to hold parts of the body so that:

• The skin graft can be immobilized and protected

while healing
• The skin can be prevented from shrinkage and
contractures while healing
• The new grafts and flaps are protected
• The deformity is prevented and/or corrected
• The ROM is maintained and/or increased
• The weak muscles can counteract the effect of
gravity
 Positioning & Splinting
Proper positioning and splinting are required to:

• Minimize edema formation

• Prevent tissue destruction
• Maintain soft tissue in an elongated state to facilitate
recovery
• Adopt the anti contracture position

Physical therapy and splinting should immediately done after

the injury as they play an important role in different body
parts function, especially in hand function
 Deformities
Pathophysiology
The typical deformities seen in the burned hand are
• Hyperextension deformity of the
metacarpophalangeal joints,
• Flexion deformity of the interphalangeal (IP) joints,
• Adduction contracture of the thumb,
• Volar flexion contracture of the wrist, and shrinkage of
the dorsal skin.
• The metacarpophalangeal joint assumes the
hyperextended position because of with joint edema.
 Dorsal Burn
• The most common deformity after a dorsal
burn injury of the hand is the ‘‘clawhand’’
deformity, which positions the hand with the
• wrist in 15 to 30 degrees of extension,
• the MP joints in 70 to 80 degrees of flexion,
• IP joints straight, and the thumb abducted.
 Palmar Burn
• Palmer hand burns require thorough
evaluation to determine the type of splinting
required.
• In general, the palmar skin will require
maximum stretching to prevent the
contracting forces of the healing burn.
Positioning
The antideformity
position of the palmar
burn consists of
• wrist extension
• MP joint extension
• IP joint extension
• digital abduction
• thumb abduction
and extension: the
‘‘open palm’’ or
‘‘pancake’’ position.
Dynamic Splint

When a patient is
unable to actively
close the fingers into
the palm, a dynamic
splint can be
fashioned that utilizes
rubber bands to
passively encourage
the digits to flex into
the palm.
Dynamic splint

• To correct
adduction
contracture that
occur in patient
with web space
burn
 Classification
There are 3 main types of splints usually used
with burn patients namely
• Static
• Static progressive
• Dynamic splints
• Static or Primary splints are used in the acute
phase for skin graft protection after surgery or anti
contracture positioning. These splints are applied to
adjacent intact skin.
• Static progressive or postural splints are used after
the graft phase when there is no sufficient ROM
obtained with static positioning and exercise. These
splints may be implemented for correction and
contractures.
• Dynamic or follow-up splints are used to increase
function by providing a slow force to stretch a
contracture or provide resistive force for exercise
 Types of splints & Orthoses for burns

There are several types of splints and orthoses we may

use to treat our burns.
• Resting Hand splints
• Finger extension splint
• Interdigital inserts
• Clavicle strap
• Axillary Splint
• Mouth Splint
• Spinal orthoses
• Foot orthoses
 Resting hand splint for burns

• Resting hand splints are used to support the hand

and wrist joints so that they heal without losing range
of motion. While burns heal, the skin can shrink
which may cause contractures and deformities.
• These splints are worn while you’re resting and hold
your hand in a comfortable position to reduce
swelling and pain.
• A common schedule would be to wear it at night
while sleeping and take it off during the day for
exercise and activity.
 Finger extension splints for burns

• The purpose of finger extension splints is to

support a finger joint so that it heals without
contracting. This helps prevent deformities.
• It’s common to wear finger extension splints
at night while resting and take them off during
the day while exercising or doing other
activities.
 Interdigital inserts for burns

• Interdigital splints are inserts that you wear in

the web spaces between your fingers and
thumb.
• They’re used to prevent the skin from
shrinking as it heals and to restore range of
motion by stretching the skin.
• How long and when you wear them varies, but
patients usually wear them full-time under
compression glove
 Clavicle strap for burns
• A clavicle strap can prevent the skin around
your arm and clavicle from shrinking while you
recover. It also helps maintain your range of
motion by keeping your skin loose and
healthy. The length of time you’ll wear the
clavicle strap varies depending on your
specific burn injuries. You might wear it full-
time or part-time
 Axillary or airplane splint for burns

• An airplane splint, sometimes called an

axillary splint, is used for burns on the
shoulders or underarms (axilla). It’s called an
airplane splint because it holds your arm out
to the side, like an airplane wing.
 Mouth splints for burns

• If the skin around your mouth shrinks, you can develop a

condition called microstomia.
• Microstomia makes it difficult to open your mouth, eat,
speak clearly, brush your teeth and complete dental
work.
• There are a variety of mouth splints available, some of
them are prefabricated and some are custom made to
each patient.
• Most people wear mouth splints on a part-time schedule
2-4 times a day.
 Spinal Orthoses
• Burns on the back or torso may require the
use of spinal orthoses
• such as back braces or support garments, to
protect and stabilize the injured area during
the healing process
 Foot Orthoses
• Burn injuries on the feet can cause deformities
and difficulties with walking.
• Custom-made foot orthoses, such as insoles or
shoe modifications, can help distribute
pressure, support the arches, and improve gait
 Points To Remember
• It's important to note that the use of orthotic
devices in burn management should be guided by a
healthcare professional, such as a physical therapist,
occupational therapist, or a burn specialist.
• Customization is often necessary to address the
unique needs of each patient and their specific burn
injuries.
• Additionally, proper patient education and follow-up
care are essential for achieving the best outcomes in
burn management with the use of orthoses