|IDEAS AND INNOVATIONS
|Year : 2012 | Volume
| Issue : 1 | Page : 72-74
Our modification of anti-deformity splint in acute hand burns
Ganesh Chaudhari, Devesh Mehta, Nischal Naik, Nilesh Ghelani, Pratap Nadar, Hemant Patil
Department of Burns and Plastic Surgery, Smt. N.H.L. Municipal Medical College and Shardaben Hospital, Ahmedabad, Gujarat, India
|Date of Web Publication||13-May-2013|
6, R.M.O. Quarters, Shardaben Hospital, Saraspur, Ahmedabad, Gujarat - 18
Source of Support: None, Conflict of Interest: None
Splinting the hand in an anti-deformity position is mandatory in the management of acute hand burns. In this article, we demonstrate our modification of anti-deformity splint, made of an aluminium framework and rubber bands and show its advantages over traditional plaster of paris (POP) splint.
Keywords: Acute hand burns, anti-deformity position, aluminium framework
|How to cite this article:|
Chaudhari G, Mehta D, Naik N, Ghelani N, Nadar P, Patil H. Our modification of anti-deformity splint in acute hand burns. Indian J Burns 2012;20:72-4
|How to cite this URL:|
Chaudhari G, Mehta D, Naik N, Ghelani N, Nadar P, Patil H. Our modification of anti-deformity splint in acute hand burns. Indian J Burns [serial online] 2012 [cited 2020 Jun 2];20:72-4. Available from: http://www.ijburns.com/text.asp?2012/20/1/72/111793
| Introduction|| |
An acutely burned hand is known for its tendency to acquire an intrinsic minus position in case of burns involving both dorsal and volar surfaces of hand, as well as in isolated dorsal hand burns. Traditionally, POP splints were given to place the hand in anti-deformity position (wrist joint in 30-40 degree extension, metacarpophalangeal (MP) joints in 90 degree flexion, interphalangeal (IP) joints extended and first web space in maximally abduction. ,
To overcome various problems associated with POP splint, we devised an anti-deformity splint made of aluminium framework and rubber bands costing only one-third the POP splint, which is patient friendly, light weight and reusable while giving near perfect anti-deformity position.
| Materials and Methods|| |
We used our aluminium splint in 15 patients, 14 of whom were adults (twelve adult females and two adult males) and one was a child. Age range was between four years and 58 years. Patients with acute thermal burns involving less than 50% total body surface area, having superficial to deep second degree hand burns were included in the study. All patients were admitted with an average duration of hospital stay of one month and an average post treatment follow-up of three months.
The requirements for making the splint were
Aluminium bar is molded by hand or by using bender as shown in following schematic diagram [Figure 1]. Measurement of middle finger of the patient is taken from MP of finger and used to plan the framework.
- Aluminium rod (5 mm diameter) - 120 centimeter for adults and 60 centimeter for children
- Rubber bands (small and big size)
- 22 gauge needle cap.
|Figure 1: Schematic diagram of aluminium framework- Antideformity splint|
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Rubber bands, two to three in number are required in the proximal group and six to eight in the distal group (but number of rubber bands can be increased as per requirement). They were placed in the framework as shown in [Figure 2], [Figure 3] and [Figure 4] in two groups at a distance so that the proximal phalanges of all fingers were positioned beneath the proximal group of rubber bands and the distal phalanges of all fingers were positioned over the distal group of rubber bands [Figure 4]. In uncooperative and unconscious patients finger position can be maintained by fixing them to the aluminium frame with the help of sutures [Figure 5]. As proximal and distal phalanges of all fingers do not lie at the same level, uniform support and maintenance of angle can be achieved by placing extra few rows of rubber bands in distal group as per requirement. For maintenance of first web space and thumb support a thick roll of six inch bandage can be used [Figure 6] and [Figure 7]. The hand should rest on the aluminium bar PQ at the midpalmar crease. Forearm should be dressed with Gamjee and rested as shown in [Figure 8]a.
|Figure 7: Antideformity splint with modification (for thumb support, maintainance of first web space and positioning)|
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|Figure 8: (a) Patient with antideformity splint in position and (b) Uncooperative patient with antideformity splint in position with strings attached to I.V. stand for limb elevation|
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| Results|| |
During the course of hospital stay, we observed that all patients using the splint were maintaining near perfect anti-deformity position. Physiotherapy was possible without removal of the splint. Lighter weight of the splint improved patient compliance and it also proved more cost effective than the traditional splints.
Out of 15 patients, only five patients followed up for the initial six months after discharge. Maximum period of follow-up was one year in one patient with average follow-up period being three months. During this follow up period, none of the patients developed hand contractures [Figure 9] and [Figure 10].
| Discussion|| |
Positioning of the burned hand is vital to bringing about the best functional outcome. Positioning should begin immediately at admission to the burn center and be continued throughout the treatment and rehabilitation.
Antideformity positioning can be achieved by multiple means such as splinting, mechanical traction, cut out trough foam, pillows, strapping mechanisms and serial casting.  Whatever the method of splinting (material of choice, design, and application schedule) the burn therapist uses, the goal is to achieve the best functional outcome.
Traditionally used POP splints for acute hand burns required frequent change of splints due to wear and tear, and bending of the splint resulting in improper anti-deformity positioning. Due to daily dressings, contact with antibiotic cream, blood, and purulent discharge the splint becomes wet and becomes a source of infection. Cost of the POP splint compared to our aluminium antideformity splint is considerably high and it requires frequent changes. Our splint can be sterilized by autoclaving or cleaning with antiseptic solution and hence it becomes reusable in patients with similar body habitus. Time required in preparation of splint is less than 10 minutes which is comparable to other splints. Compared to POP splint our splint is light weight and improves patient compliance. Thermoplast/orthoplast/aquaplast material is also used to make splints which are light weight and reusable, but it has cost limitations and is not easily available. Daily hand therapy being an essential part of hand burn treatment, can be given with the aluminium splint in situ after rubber band removal. This is not possible with other traditional splints which need to be removed before therapy.
The splint can be used post-operatively also after skin grafting to maintain position. Crowding of fingers is unusual but if it does occur, it can be tackled by decreasing the number of rubber bands in the proximal group. Hand elevation can be easily achieved by suspending the frame with the help of a bandage from a drip stand [Figure 8]b.
However the limitations of our aluminium frame splint are that it requires a bending and cutting instrument. Also, it cannot be used in severe (third degree) burns as it requires a stronger splintage such as a Banjo external fixator to maintain an antideformity position. 
| Conclusion|| |
The aluminium anti-deformity splint for acute hand burns is cost effective, has better patient compliance, and maintains a near perfect anti-deformity position in second degree acute hand burns. However, a longer period of follow-up of these patients is required to demonstrate the long term effectiveness of this splint in preventing post burn hand deformities.
| References|| |
|1.||Fess EE, Philips CA. Hand splinting-principles and methods. 2 nd ed. St Louis: CV Mosby; 1987. p. 125-254. |
|2.||Germann G, Weigel G. The burned hand, Green's operative hand surgery. 6 th edn. Burn Centre, BG Trauma Centre, Ludwigshafen, Germany; 2009; Volume 2 page 2093-4 . |
|3.||Larson DL, Evans EB, Abston S, Lewis SR. Skeletal suspension and traction in the treatment of burns. Ann Surg 1968;168:981-5. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10]