Outcomes of Early Use of an End of Range Axilla Orthotic in Children Following Burn Injury

Abstract

Scar contracture is a significant complication of burn injury. This study aimed to describe outcomes of early axilla orthotic use at end of range abduction in children, following a burn to the axilla region. A retrospective review of 76 children (mean age 3.9 years [SD 3.6]) treated at a tertiary children’s hospital from 2006 to 2016 was conducted. No child developed axilla contracture for the duration of the 2-year study follow-up with no adverse events recorded. If orthotic use was ceased <60 days post-burn, it was considered not an essential intervention to maintain range of movement, leaving 49 children using the orthotic ≥60 days. Compared with the children who ceased orthotic use in <60 days, children who required the orthotic ≥60 days had a significantly higher frequency of deep-dermal burn (59 vs 25%, p = .01), flame mechanism (25 vs 5%, p = .03), and burn injury distribution involving the anterior trunk, flank, and arm (18 vs 3%, p = .03). Early signs of contracture, considered loss of full axilla range or significant banding, developed in nine children within 3 months post-burn. With intensive therapy, all returned to full axilla range by 9 months post-burn. Children with skin tension at end of range shoulder movement at the 1-month clinical assessment were 11 times more likely to develop early signs of contracture (95% confidence interval [CI]: 1.9–62.1, p = .007). Intensive orthotic use at end of range shoulder abduction in children with axilla burns is well tolerated. When undertaken with ongoing therapist review, full axilla range can be maintained.

Scar outcomes for conservatively managed children post burn injury: A retrospective study

“…Consequently, these children represented a large percentage of the HTS groups at both time points post burn. Prior research reports HTS prevalence rates for all children post burn injury as 16%–69%, 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 and for children treated conservatively as 10.4%–41.0%. 3 , 5 , 6 , 8 , 14 Similarly, the current study found the prevalence of HTS to be 56.1% at 3–6 months, and 16.3% at 12–18 months.…”

“… 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 This wide range stems from varied study populations, the use of multiple measurement tools and varied values in the subjective scar scales used to determine the presence or definition of HTS. 15 Differing follow‐up durations during the scar development and maturation phases, ranging from 1 week to 5 years, 3 , 5 , 6 , 8 , 9 , 10 , 14 further compounds the variability of HTS prevalence within the literature. The lack of a formal scar definition within the burn community challenges researchers and clinicians abilities to compare outcomes and incidences of HTS.…”

“… 23 However, paediatric burn injury literature on scar outcomes predominantly includes children with larger TBSA involvement, and deep dermal or full thickness depth, who often receive inpatient management and skin grafting. 3 , 5 , 9 , 18 To our knowledge, only two studies have investigated children who receive conservative management for their burn injuries, that are minor (<10%TBSA), partial thickness, or heal between 14 and 21 days. 3 , 6 Furthermore, in Australia and New Zealand, 92% of all paediatric burn injuries are <10% TBSA, of which the majority receive outpatient management.…”

Scar Contractures

“…The shoulder is mobile anteriorly, posteriorly, and laterally, needing a full skin mobility in all aspects of the region. A large range of functional deficits may be encountered in burns, with a good reactivity to early physiotherapy and specifically to range axilla orthotic, as demonstrated [3] (. Figs.…”

Comparison of the Effects of Stretching and Splinting in Improving the Range of Motion and Functional Status for Prevention of Post-Burn Axillary Contracture

“…Recent studies have highlighted the effectiveness of stretching in enhancing the range of motion, particularly in flexion and abduction among upper limb burn patients, thereby reducing the incidence of axillary contracture (4,14,15). Conversely, other research emphasizes the benefits of positioning patients in airplane splints to provide abduction support, which not only improves the range of motion in the shoulder but also enhances patient mobility and functional status (5,16,17). This comparative analysis aims to elucidate the relative impacts of stretching and splinting in improving shoulder range of motion in post-burn axillary contracture patients, with the ultimate goal of decreasing the development of contracture and enhancing the recovery rate and functional status of these individuals.…”