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Murtaugh B, Warthman R, Boulter T. Rehabilitation Management of the Burned Hand. Phys Med Rehabil Clin N Am 2023; 34:767-782. [PMID: 37806696 DOI: 10.1016/j.pmr.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Burns to the hands constitute a small total surface area burn, but can result in significant functional challenges and disability. The complexity of multiple anatomical structures and intricate interplay of bones, muscles, and connective tissues requires specialized knowledge of how burns of the hand can affect function and independence. This article will provide an evidence-based overview of rehabilitation of the burned hand across the burn care continuum including a focus on evaluation, pain management, treatment interventions, and outcome assessment. Additionally, various deficits that can put the hand at significant risk for loss of function will be discussed. Finally, the authors will address the special considerations and treatment caveats of addressing the pediatric hand burn.
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Affiliation(s)
- Brooke Murtaugh
- Department of Rehabilitation Programs, Madonna Rehabilitation Hospitals, 5401 South Street, Lincoln, NE 68506, USA.
| | - Renee Warthman
- Arizona Burn Center, Valleywise Health Medical Center, 2601 East Roosevelt Street, Phoenix, AZ 85008, USA
| | - Trudy Boulter
- Children's Hospital Colorado Burn Center, 13123 East 16th Avenue, Aurora, CO 80045, USA
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Chen G, Wang W, Wang P, Zhang N, Xiu X, Zhao J. Clinical Application of Restrictive Brace Combined with Psychological Intervention after Replantation of Severed Fingers in Children. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:9631858. [PMID: 35813429 PMCID: PMC9262523 DOI: 10.1155/2022/9631858] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/06/2022] [Accepted: 06/10/2022] [Indexed: 11/18/2022]
Abstract
Objective After replantation of severed fingers in infants, the utility model patent upper limb restrictive brace-assisted bed rest braking, combined with psychological intervention, can alleviate children's anxiety, so as to reduce the occurrence of vascular crisis. Methods The study period was from April 2015 to July 2018. In this paper, 30 children with finger injuries in hand surgery in the CIS electronic medical record system of Cangzhou Integrated Traditional Chinese and Western Medicine Hospital were selected as the research objects. Replantation was performed in 30 infants with severed fingers. Among them, 15 cases were applied with the method of aircraft chest arm gypsum splint combined with sedative drug braking and the utility model patented product upper limb restrictive brace fixation-assisted bed rest braking, and the method of psychological intervention was applied at the same time. Results Among the 15 fingers in the control group, 6 had vascular crisis and 1 in the experimental group. The incidence of vascular crisis in the experimental group was lower, and the difference between the two groups was statistically significant (P < 0.05). The patients were followed up for 9~18 months, with an average of 9.72 ± 1.07 months. In the control group, 15 cases of severed fingers survived, and there were 13 cases of replantation finger necrosis in 2 cases of intractable arterial crisis. In the experimental group, 14 cases of severed fingers survived in 15 cases and there was 1 case of replanted finger necrosis in intractable arterial crisis after operation. There was no significant difference in the survival rate between the two groups (P > 0.05). In addition, the replanted finger function was evaluated. In the control group, 9 cases were excellent, 4 cases were good, and 1 case was fair. In the experimental group, 14 cases were excellent, 1 case was good, and 0 case was fair. The functional evaluation of the experimental group was better than that of the control group, and the difference between the two groups was statistically significant (P < 0.05). Conclusion For infants after replantation of severed fingers, the application of the utility model patented product upper limb restrictive brace can effectively make up for the insufficient fixation of aircraft chest arm gypsum splint, reduce the occurrence of vascular crisis, and assist children in bed. In addition, the application of psychological intervention can reduce children's postoperative crying and is conducive to children's postoperative recovery.
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Affiliation(s)
- Guangxian Chen
- Cangzhou Hospital of integrated Traditional Chinese Medicine and Western Medicine of Hebei, Hebei 061000, China
| | - Wei Wang
- Cangzhou Hospital of integrated Traditional Chinese Medicine and Western Medicine of Hebei, Hebei 061000, China
| | - Ping Wang
- Cangzhou Hospital of integrated Traditional Chinese Medicine and Western Medicine of Hebei, Hebei 061000, China
| | - Ning Zhang
- Cangzhou Hospital of integrated Traditional Chinese Medicine and Western Medicine of Hebei, Hebei 061000, China
| | - Xiaolei Xiu
- Cangzhou Hospital of integrated Traditional Chinese Medicine and Western Medicine of Hebei, Hebei 061000, China
| | - Jianyong Zhao
- Cangzhou Hospital of integrated Traditional Chinese Medicine and Western Medicine of Hebei, Hebei 061000, China
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McAlister P, Hagan G, Lowry C, Mullen S. Fifteen-minute consultation: Management of paediatric minor burns. Arch Dis Child Educ Pract Ed 2022:archdischild-2021-323229. [PMID: 35063949 DOI: 10.1136/archdischild-2021-323229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/15/2021] [Indexed: 11/04/2022]
Abstract
Burn injuries are a common presentation to the paediatric emergency department (PED) and are painful, distressing and may have long-term sequelae. In adhering to the first aid principles of burns management, we aim to alleviate pain, prevent bacterial contamination and minimise the extent of injury. First aid involves cooling the burn and covering with an appropriate material while simultaneously providing analgesia. Assessing the severity (depth and total body surface area) of the burn are important for prognostication with implications for management. It is imperative to consider non-accidental injury in burns, which be present in 10% of cases .
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Affiliation(s)
- Peter McAlister
- Paediatric Emergency Department, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Gary Hagan
- Paediatric Emergency Department, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Christopher Lowry
- Paediatric Emergency Department, Royal Belfast Children's Hospital, Belfast, UK
| | - Stephen Mullen
- Paediatric Emergency Department, Royal Belfast Hospital for Sick Children, Belfast, UK .,Faculty of Medicine, Health and Life Sciences, Queen's University, Belfast, UK
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Lee A, Wang Y, Nadarajah CC, Lipner SR. Cross-sectional analysis of national electronic injury surveillance system for burn injuries presenting to United States emergency departments 2000-2018. Burns 2021; 48:1347-1354. [PMID: 34924228 DOI: 10.1016/j.burns.2021.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/21/2021] [Accepted: 11/15/2021] [Indexed: 11/17/2022]
Abstract
Patients with burns commonly present to Emergency Departments (EDs), in addition to burn centers. Patients at burn centers typically have more severe burns than those at EDs, and previous studies have analyzed burn center databases. To update the overall burn epidemiology in the United States (US), we analyzed burn injury trends and sources across all age groups using the National Electronic Injury Surveillance System (NEISS), which collects all injuries reported to US EDs. A total of 97,986 burn injuries were recorded in NEISS, 2000-2018. We found a downward trend in the pediatric burn rate and an upward trend in the adult burn rate. Almost half of burns were in children (48.41%), especially in those under 5 (29.79%), and slightly more common in men (53.93%). Most were treatable in the ED (87.83%) and hot water was the most common source overall (20.88%), followed by hair curlers for children less than 2 years old, ranges/ovens for 2 to <5 years, microwaves for 5 to <10 years, and cookware for 10 to <18 years and adults ≥18 years. The most common injured region was the hand for all age groups (34.44%). Although most burn injuries were potentially preventable, the overall burn rate did not decrease 2000-2018. Therefore, we offer guidance on prevention strategies for high-risk sources and age groups.
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Affiliation(s)
- April Lee
- The State University of New York Downstate College of Medicine, 450 Clarkson Ave, Brooklyn, NY 11203, USA
| | - Yu Wang
- Wake Forest University, Department of Dermatology, 475 Vine Street, Winston-Salem, NC 27101, USA
| | | | - Shari R Lipner
- Weill Cornell Medicine, Department of Dermatology, 1305 York Avenue, NY 10021, USA.
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Zhou YQ, Zhou JY, Luo GX, Tan JL. Effects of early rehabilitation in improvement of paediatric burnt hands function. World J Clin Cases 2021; 9:9741-9751. [PMID: 34877313 PMCID: PMC8610915 DOI: 10.12998/wjcc.v9.i32.9741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/07/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hands are one of the most common burn sites in children. Hypertrophic scar contractures in hands after wound healing result in further reductions in their range of motion (ROM), motility, and fine motor activities. Rehabilitation can improve the function of hands. But the optimal time of rehabilitation intervention is still unclear. Therefore, this study was designed to investigate the effects of early rehabilitation management of paediatric burnt hands and to compare the efficacy between early and later rehabilitation intervention.
AIM To investigate the effects of early rehabilitation management of paediatric burnt hands.
METHODS A total of 52 children with burnt hands were allocated into the early intervention group (≤ 1 mo from onset) and a late intervention group (> 1 mo from onset) between January 2016 and December 2017. The children received the same rehabilitation programme including skin care, scar massage, passive ROM exercises, active ROM exercises, compression therapy, orthotic devices wearing and game or music therapy. Rehabilitation assessments were performed before and after the rehabilitation treatment.
RESULTS In the early intervention group, the ROM of the hands was significantly improved after rehabilitation (P = 0.001). But in the late group the effect was not significant statistically (P = 0.142). In the early group, 38.5% of the patients showed significant improvement, while in the late group, 69.2% of the patients showed no significant improvement. The time from onset to posttraumatic rehabilitation (P = 0.0007) and length of hospital stay (P = 0.003) were negatively correlated with the hand function improvement. The length of rehabilitation stay was positively correlated with the hand function improvement (P = 0.005).
CONCLUSION These findings suggest that early rehabilitation might show better results in terms of ROM.
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Affiliation(s)
- Ya-Qin Zhou
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injuries, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, The Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Jun-Yi Zhou
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injuries, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, The Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Gao-Xing Luo
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injuries, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, The Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Jiang-Lin Tan
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injuries, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, The Third Military Medical University (Army Medical University), Chongqing 400038, China
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Sorenson TJ, Mohr WJ, Mahajan AY. Pediatric Hand Burns Requiring Emergency Care in the United States. J Burn Care Res 2021; 44:704-708. [PMID: 34297093 DOI: 10.1093/jbcr/irab144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Indexed: 11/12/2022]
Abstract
PURPOSE Hand and finger burns represent a relatively common occurrence in children, and serious injuries may require surgical intervention to prevent long-term disability. This study examines the epidemiological characteristics of pediatric patients presenting for emergency care of hand and finger burns within the United States (US). METHODS We report a cross-sectional study of patients reported to the National Electronic Injury Surveillance System (NEISS) from January 1, 2010 to December 31, 2019. Patients were included in our study if they were younger than 18 years old and evaluated for an isolated hand or finger burn. United States census data from the same period were utilized for determining epidemiological estimates of injury incidence. RESULTS During the 10-year study period, an estimated 300,245 pediatric hand and finger burns were treated in 778,497,380 person-years: an incidence rate of 38.6 burns per 100,000 person years. Most treated burns occurred in the 1- to 2-year age group (28.3%) with an approximate 50% reduction in incidence for each 1-year age stratum until stabilizing at 6 years. Most burns occurred in white children (58%), but Black children had a higher incidence than white children when corrected for US population (45.15 burns versus 21.45 burns per 100,000 person-years). The most common etiology was a stove or oven (1595/10420; 15%). CONCLUSIONS Pediatric hand and finger burns occurred most frequently in young children from the oven and/or stove. We urge that parents be assertively counseled about potential burn risks to their young children's hands and fingers, especially once they reach ambulatory age.
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Affiliation(s)
- Thomas J Sorenson
- Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | - William J Mohr
- Department of Critical Care and Burn Surgery, Regions Hospital, Saint Paul, Minnesota, USA
| | - Ashish Y Mahajan
- Department of Plastic Surgery, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Plastic Surgery, Regions Hospital, Saint Paul, Minnesota, USA
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