Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
J Burn Care Res. 2022 May 17;43(3):640-645. doi: 10.1093/jbcr/irab161.
Burn scar contracture (BSC) is a common pathological outcome following burn injuries, leading to limitations in range of motion (ROM) of affected joints and impairment in function. Despite a paucity of research addressing its efficacy, static splinting of affected joints is a common preventative practice. A survey of therapists performed 25 years ago showed a widely divergent practice of splinting during the acute burn injury. We undertook this study to determine the current practice of splinting during the index admission for burn injuries. This is a review of a subset of patients enrolled in the Burn Patient Acuity Demographics, Scar Contractures and Rehabilitation Treatment Related to Patient Outcome Study (ACT) database. ACT was an observational multicenter study conducted from 2010 to 2013. The most commonly splinted joints (elbow, wrist, knee, and ankle) and their seven motions were included. Variables included patients' demographics, burn variables, rehabilitation treatment, and hospital course details. Univariate and multivariate analysis of factors related to splinting was performed. P < .05 was significant. Thirty percent of the study population (75 patients) underwent splinting during their hospitalization. Splinting was associated with larger burns and increased injury severity on the patient level and increased involvement with burns requiring grafting in the associated cutaneous functional unit (CFU) on the joint level. The requirement for skin grafting in both analyses remained independently related to splinting, with requirement for grafting in the associated CFU increasing the odds of splinting six times (OR = 6.0, 95% CI = 3.8-9.3, P < .001). On average, splinting was initiated about a third into the hospital length of stay (LOS, 35 ± 21% of LOS) and splints were worn for 50% (50 ± 26%) of the LOS. Joints were splinted for an average 15.1 ± 4.8 hours a day. The wrist was most frequently splinted joint being splinted with one third of wrists splinted (30.7%) while the knee was the least frequently splinted joint with 8.2% splinted. However, when splinted, the knee was splinted the most hours per day (17.6 ± 4.8 hours) and the ankle the least (14.4 ± 4.6 hours). Almost one third had splinting continued to discharge (20, 27%). The current practice of splinting, especially the initiation, hours of wear and duration of splinting following acute burn injury remains variable. Splinting is independently related to grafting, grafting in the joint CFU, larger CFU involvement and is more likely to occur around the time of surgery. A future study looking at splinting application and its outcomes is warranted.
烧伤后挛缩（BSC）是烧伤后常见的病理性结果，导致受累关节活动范围（ROM）受限和功能障碍。尽管针对其疗效的研究很少，但对受累关节进行静态夹板固定是一种常见的预防措施。25 年前对治疗师进行的一项调查显示，在急性烧伤期间，夹板固定的做法存在很大差异。我们进行这项研究是为了确定在烧伤患者入院期间进行夹板固定的当前做法。这是对参与烧伤患者急症、疤痕挛缩和与患者结局相关康复治疗研究（ACT）数据库的一部分患者进行的回顾性研究。ACT 是一项 2010 年至 2013 年进行的观察性多中心研究。包括最常夹板固定的关节（肘部、腕部、膝部和踝部）及其七个运动。变量包括患者的人口统计学、烧伤变量、康复治疗和住院过程细节。对与夹板固定相关的因素进行了单变量和多变量分析。P<.05 有统计学意义。研究人群的 30%（75 名患者）在住院期间接受了夹板固定。夹板固定与烧伤面积较大和患者严重程度增加有关，与需要植皮的关节相关皮区功能单位（CFU）烧伤程度增加有关。在这两项分析中，植皮的需要都与夹板固定有关，相关 CFU 中的植皮需要使夹板固定的几率增加六倍（OR=6.0，95%CI=3.8-9.3，P<.001）。平均而言，夹板固定在住院时间（LOS）的三分之一左右开始（LOS 的 35±21%），夹板固定时间为 LOS 的 50%（50±26%）。关节平均每天夹板固定 15.1±4.8 小时。最常夹板固定的关节是手腕，三分之一的手腕（30.7%）夹板固定，而最不常夹板固定的关节是膝盖，只有 8.2%。然而，当夹板固定时，膝盖每天夹板固定的时间最长（17.6±4.8 小时），脚踝最短（14.4±4.6 小时）。近三分之一的患者（20 名，27%）在出院时仍继续夹板固定。急性烧伤后夹板固定的当前做法，尤其是开始时间、佩戴时间和夹板固定时间仍然存在差异。夹板固定与植皮、关节 CFU 中的植皮、更大的 CFU 受累有关，更可能发生在手术前后。有必要进行一项研究来观察夹板的应用及其效果。
