Rehabilitation of Hand Burns

Rehabilitation of Hand Burns
Study / Main Purpose / Research Design / Sample / Outcome
Measures / Results / Study Category / Level of Evidence
Ause-Ellias, 199484 / Evaluate the effectiveness of mechanical compression in decreasing hand edema. / Evaluation of hand volume before and after treatment with a Jobst Intermittent Compression Pump. Treatment was an average of 5.6 treatments over 2 weeks. / 9 chronically edematous hands of 5 patients. / Hand volume, hand range of motion / Mean pretreatment hand volume was 628.47 ml and post treatment volume was 619.02. This difference was not statistically significant. No statistical change in hand range of motion. / Therapeutic / IV
Barillo, 199781 / Evaluation of results of a surgical and rehabilitative treatment protocol for burned hands. / Case series. Standard treatment protocol with goal of wound closure within 14 days, range of motion therapy, static splinting, continuous passive motion. / 43 patients with 82 hands with severe burns. Average TBSA 19.4%. 89% had hand autografting procedure by day 16. / Total active motion (TAM) of the hand and grip strength at the time of hospital discharge. Normal TAM is 270 degrees and greater than 220 degrees is considered functional. A grip strength of greater than 65 pounds is considered functional. / Average of 220.6 degrees of total active motion at discharge and 229.9 degrees at 3 months after injury. Mean grip strength of 60.8 pounds at discharge and 66 pounds at 3 months. / Therapeutic / IV
Chung, 199980 / Assess the sensitivity of the Michigan Outcome Questionnaire (MHQ) to clinical change in patient status. / Case series. / 187 patients with chronic hand disorders completed a baseline MHQ and a second MHQ 6-18 months later (follow-up 49%) / MHQ questionnaire and patients self-assessment of clinical change. / The MHQ demonstrated good correlation with the patients assessment of clinical change. / Prognostic / IV
Gulati, 200491 / Evaluation of the Joshi External Stabilizing System (JESS). / Retrospective chart review / 218 patients with severe burns treated with JESS from 1982-2002 with burns 4 months to 20 years before treatment. / Clinical outcome / Complete correction of the deformity in the large majority of patients and increased number of patients with new independence with ADL’s after the surgery. / Prognostic / IV
Harvey, 199682 / Evaluation of a computer assisted impairment evaluation system for upper extremity function. / Case series / 80 upper extremities evaluated with the system. / Time to complete examination and correlation of computer and conventional examination. / Computer system demonstrated good correlation coefficients and took less time to complete. / Prognostic / IV
Ilhami, 200392 / Evaluation of the use of an external fixator in the treatment of fixed joint contractures. / Case series / 6 hands in 5 patients previous failed reconstructive surgeries. / Clinical outcome / Improved hand function and motion after treatment. / Therapeutic / IV
Lowell, 200386 / Evaluation of the use of Coban wrap to decrease hand edema / Case study / One subject with a 46% TBSA burn. After surgery one hand was wrapped in Coban and the other in standard gauze dressing. Random selection was used and right hand was wrapped in Coban. Patient was right hand dominant. / Measurement of circumferential measurements of the hand/fingers, active ROM, grip strength, and hand function up to 17 days post-op. / There was a larger decrease in circumferential measurement in hand wrapped with Coban. / Therapeutic / IV
Madhuri, 199893 / Report of the use of the Ilizarov method for treatment of burn contracture. / Case report / 44-year-old man with a history of burn at age of 6 months with severe wrist/hand contracture. Treated with Iliazrov device. / Clinical outcome / Deformity was corrected over a period of 6 weeks. / Therapeutic / IV
Manigandan 200388 / Description of need to splint the wrist in axillary burns. / Description of splinting technique to extend the axillary splint to include the wrist. / No subjects / None / None / Therapeutic / IV
Maslauskas, 200473 / Describe the epidemiology of patients with severe hand burns / Case series / A total of 246 cases admitted to Kaunas University of Medicine Hospital (Lithuania) during 4 selected years (1985, 1995, 2001, 2002) / Clinical outcome / 74.4% were male, average age 40, median TBSA 12%, early skin grafting in 29.4% and delayed skin grafting (primarily in 1985, 1995) in 70.6%.
There was a significant decrease in median hospital length of stay from 35 days in 1985 to 19 days in 2002. / Prognostic / IV
Nuchtern, 199579 / Description of the treatment of 4th degree hand burns. / Case series / 25 patients (35 hands) with 4th degree burns treated over a 10 year period / Clinical outcome / 11 hands were treated with K-wire immobilization and grafting. 33 amputations in 21 hands including one above elbow, 5 below elbow, 15 MCP level amputations. Evaluation of strength and ROM showed severe impairments in 7 hands and 7 with moderate effects, and 11 with minor sequelae. / Prognostic / IV
Richard, 199489 / Description of the fabrication of hand splints. / Descriptive / None / None / Described technique to compensate for bandage thickness in the fabrication of hand splints. / Therapeutic / IV
Sheridan, 199577 / Description of the outcome of hand burns / Case series / 659 patients with 1047 burned hands admitted to burn center over 10 years. All treated in a uniform way with grafting, Kirschner wires, ROM 2x/day and splinting. 646 burned hands were followed for at least 6 months. / Clinical outcome / In patients with deep dermal or full-thickness injuries that required grafting, 80.9% were able to perform ADL’s independently without compensatory techniques or equipment and 18.4% were independent with ADL’s with compensatory techniques or equipment. In patients with burns that involved the underlying tendon, joint capsule, and bone 81% were able to perform ADL’s independently with compensatory techniques or equipment and 9.4% were unable to perform ADL’s. / Prognostic / III
Sheridan, 199978 / Description of the outcome of hand burns in children / Case series / 495 children admitted to burn center with 698 burned hands. Treatment was completed in a uniform way. / Clinical outcome / In subjects with deep burns requiring surgery but not to bone, 85% had normal hand function, 9% had abnormal function but could complete ADL’s and 6% were unable to complete ADL’s. In subjects with burn involving bone requiring the use of K wires, 20% had normal function, 51% had abnormal function, and 25% were unable to complete ADL’s / Prognostic / IV
Smith, 199875 / Description of management techniques for severe hand burns. / Descriptive / None / No outcome / Description of treatment of hand burns. / Therapeutic / IV
Torres-Gray, 199676 / Results of a questionnaire distributed at a breakfast session at the 1993 American Burn Association Meeting. / Descriptive / 38 respondents to questionnaire to identify common post burn deformities and treatment obstacles. / Results of questionnaire / The most common deformities were thumb web space contractures, PIP joint contractures, and 5th digit boutoniere deformities. Barriers to treatment included prolonged immobilization, lack of communication and support from physicians, noncompliance with garments and splints / N/A / IV
Umraw, 200474 / Comparison of 2 methods of hand function assessment. / Case series / 20 patients with hand burns. All had surgery 2 or 3 days after their burn injury. Evaluation completed at least 3 months after burn injury. / Results of evaluation with the Michigan Hand Outcomes Questionnaire (MHQ), a subjective self report measure and the Test d’Evaluation des Membres Superieurs des Personnes Agees (TEMPA), a Objective assessment of hand function. / Significant correlation of the total scores for the MHQ and TEMPA. The MHQ showed that 68% of patients reported decreased hand function and the level of disability as measured by the TEMPA was low. / Prognostic / IV
Van Straten, 200090 / Description of a new hand splint technique. / Case series / The splint was used on 15 patients and 20 hands. The splint is made of thermoplastic material with a dorsal outrigger that provides passive extension of the MCP joints and active resistive flexion. / Clinical outcome / Specific data not reported, but the paper reported on decreased cost of splinting and reduction of therapy sessions while maintaining expected progress toward treatment goals. / Therapeutic / IV
Van Zuijlen, 199983 / Description of the outcome of hand burns. / Retrospective Case Series / 88 patients (143 burned hands) admitted to burn center / Jebsen hand function test. / 29 hands had impaired function and 114 hands did not have impaired function. Variables with significant predictive value for impaired hand function were finger amputation, age, impaired autograft take, percent full-thickness hand burn surface area, and full-thickness TBSA. There was no relationship between the timing of operation and long-term hand function. / Prognostic / III
Ward, 199485 / Description of the use of Coban pressure wrap in the management of hand burns. / Case report / 2 subjects with hand burns treated with Coban wraps after surgery. / Clinical outcome / Good clinical results / Therapeutic / IV
Weinstock-Zlotnick, 200487 / Compare the effect of pressure garment work gloves and standard pressure garment gloves on functional hand use. / Repeated measures with the standard glove serving as the control and the work glove as the experimental condition. Each glove was worn for one week prior to testing and testing was separated by a period of 1-2 weeks. / 2 subjects with 3 burned hands / Grip strength, hand function, functional sensation, and functional task scores / Decreased grip and pinch strength and functional sensation with work gloves. Better performance with work glove on functional tasks involving gross and static fine-motor movements and simple dynamic fin-motor movements. / Therapeutic / IV