Ann Rehabil Med.  2011 Dec;35(6):880-886. 10.5535/arm.2011.35.6.880.

Effects of Modified Dynamic Metacarpophalangeal Joint Flexion Orthoses after Hand Burn

• Choi JS
• Mun JH
• Lee JY
• Jeon JH
• Jung YJ
• Seo CH
• Jang KU

• KMID: 2266815
• DOI: http://doi.org/10.5535/arm.2011.35.6.880

Abstract

OBJECTIVE
To assess the effectiveness of modified dynamic metacarpophalangeal joint flexion orthoses for treatment of post-burn hand contractures. METHOD: We enrolled 42 hand burn patients with limited range of motion at the metacarpophalangeal joints in this study. The patients were randomly assigned into either a control or an orthotic group. Both groups received the standard rehabilitation therapy focused on hand therapy; 21 subjects in the orthotic group wore a splint for 3 hours per day for 8 weeks. Hand function was measured by active range of motion, grip strength and other assessment tools. All parameters were estimated using the Mann-Whitney U test at the beginning and the end of the treatment after 8 weeks.
RESULTS
The 21 subjects that had an orthotic intervention showed significant improvement in the range of motion at 2nd, 3rd, 4th and 5th metacarpophalangeal joints (p<0.05). However, the grip strength was not significantly increased after the 8 weeks of treatment compared to control group (p>0.05). There was a significant difference in the hand function scales between the 2 groups (p<0.05).
CONCLUSION
The modified dynamic metacarpophalangeal joint flexion orthoses provide continuous flexion to metacarpophalangeal joint that is needed for the restoration of range of motion in post-burn hand contractures. For the clinical application of hand orthoses in patients with hand disorders, additional research into its affects are required.

Keyword

Hand deformities; Acquired; Orthotic devices; Rehabilitation; Burns

MeSH Terms

Burns
Contracture
Hand
Hand Deformities
Hand Strength
Humans
Metacarpophalangeal Joint
Orthotic Devices
Range of Motion, Articular
Splints
Weights and Measures

Figure

• 

  Fig. 1 The subjects in the orthotic group fitted the modified dynamic metacarpo-phalangeal joint flexion orthoses to control contracture of the metacarpo-phalangeal joint for 3 hours per day for 8 weeks.

Reference

1. Smith MA, Munster AM, Spence RJ. Burns of the hand and upper limb--a review. Burns. 1998; 24:493–505. PMID: 9776087.

2. Schneider JC, Holavanahalli R, Helm P, O'Neil C, Goldstein R, Kowalske K. Contractures in burn injury Part II: investigating joints of the hand. J Burn Care Res. 2008; 29:606–613. PMID: 18535473.

3. Seo CH, Jang KU, Ahn JK, Yang JI, Park DS. The types of impairments in burn patients. J Korean Acad Rehabil Med. 2006; 30:179–183.

4. Esselman PC, Moore ML. Braddom RL, editor. Issues in burn rehabilitation. Physical medicine and rehabilitation. 2006. 3rd ed. Philadelphia: Saunders;p. 1399–1414.

5. Drapé JL, Dubert T, Silbermann O, Thelen P, Thivet A, Benacerraf R. Acute trauma of the extensor hood of the metacarpophalangeal joint: MR imaging evaluation. Radiology. 1994; 192:469–476. PMID: 8029417.

6. Clavero JA, Golano P, Farinas O, Alomar X, Monill JM, Esplugas M. Extensor mechanism of the fingers: MR imaging-anatomic correlation. Radiographics. 2003; 23:593–611. PMID: 12740463.

7. Scott SC. Closed injuries to the extension mechanism of the digits. Hand Clin. 2000; 16:367–373. PMID: 10955210.

8. Young CM, Rayan GM. The sagittal band: anatomic and biomechanical study. J Hand Surg Am. 2000; 25:1107–1113. PMID: 11119670.

9. Helm PA, Kevorkian CG, Lushbaugh M, Pullium G, Head MD, Cromes GF. Burn injury: rehabilitation management in 1982. Arch Phys Med Rehabil. 1982; 63:6–16. PMID: 7034671.

10. Jung HS, Jung HS. Descriptive survey on the dimensions and the characteristics of Korean hands in general. J Ergon Soc Korea. 2003; 22:29–44.

11. Sheridan RL, Hurley J, Smith MA, Ryan CM, Bondoc CC, Quinby WC Jr, Tompkins RG, Burke JF. The acutely burned hand: management and outcome based on a ten-year experience with 1047 acute hand burns. J Trauma. 1995; 38:406–411. PMID: 7897728.

12. Frist W, Ackroyd F, Burke J, Bondoc C. Long-term functional results of selective treatment of hand burns. Am J Surg. 1985; 149:516–521. PMID: 3985290.

13. Hume MC, Gellman H, McKellop H, Brumfield RH Jr. Functional range of motion of the joints of the hand. J Hand Surg Am. 1990; 15:240–243. PMID: 2324451.

14. Kildal M, Andersson G, Fugl-Meyer AR, Lannerstam K, Gerdin B. Development of a brief version of the Burn Specific Health Scale (BSHS-B). J Trauma. 2001; 51:740–746. PMID: 11586169.

15. Son HG, Seo CH, Kim JH, Jang KU, Noh SY. Reliability and validity of a Korean version of the Burn Specific Health Scale-Brief (BSHS-B-K). J Korean Burn Soc. 2005; 8:127–136.

16. Seo CH, Jang KU, Kim DH, Hur J, Chun W, Kim JH, Son HG, Lee BC. Reliability and validity of a Korean version of michigan hand outcomes questionnaire in burn injury patients. J Korean Burn Soc. 2006; 9:102–109.

17. Jebsen RH, Taylor N, Trieschmann RB, Trotter MJ, Howard LA. An objective and standardized test of hand function. Arch Phys Med Rehabil. 1969; 50:311–319. PMID: 5788487.

18. Keith RA, Granger CV, Hamilton BB, Sherwin FS. The functional independence measure: a new tool for rehabilitation. Adv Clin Rehabil. 1987; 1:6–18. PMID: 3503663.

19. Jang KU, Choi JS, Lee JY, Seo CH, Yim HJ, Cho YS, Kim DH, Hur J, Chun W, Kim JH. Dynamic elbow flexion orthosis for elbow flexion limit in upper extremity burn. J Korean Burn Soc. 2009; 12:68–72.

20. Fess EE, Gettle KS, Philips CA, Janson JR. Hand and upper extremity splinting: principles and methods. 2005. 3rd ed. St. Louis: Elsevier Mosby;p. 86–277.

21. Fishman S, Berger N, Edelstein JE, Springer WP. American Academy of Orthopaedic Surgeon. Upper limb orthoses. Atlas of Orthotics. 1975. 2nd ed. St. Louis: CV Mosby Company;p. 163–199.

22. Jang KU, Seo CH, Kim MK, Moon CH, Yang JI, Kim JW, Park DS. The distribution analysis of orthotics in burn rehabilitation. J Korean Burn Soc. 2004; 7:98–103.

23. Richard R, Ward RS. Splinting strategies and controversies. J Burn Care Rehabil. 2005; 26:392–396. PMID: 16151283.

24. Sabapathy SR, Bajantri B, Bharathi RR. Management of post burn hand deformities. Indian J Plast Surg. 2010; 43(Suppl):S72–S79. PMID: 21321661.

25. Kong YK, Sohn ST, Han JG. A review study for grip strengths of hand. J Ergon Soc Korea. 2010; 29:715–725.

26. Park EH, Kang JY, Chun MH. Effects of resting hand splint in early stroke patients. J Korean Acad Rehabil Med. 2006; 30:261–265.

27. Pizzi A, Carlucci G, Falsini C, Verdesca S, Grippo A. Application of a volar static splint in poststroke spasticity of the upper limb. Arch Phys Med Rehabil. 2005; 86:1855–1859. PMID: 16181954.