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Long-term postoperative outcomes after axillary contracture release in children with burns
Mitell Sison-Williamson1, Anita Bagley, Tina Palmieri
1Motion Analysis Laboratory, Shriners Hospitals for Children Northern California, Sacramento, California 95817, USA.
Insights
Surgical release of axillary contractures in children significantly improves upper extremity motion and function long-term. This procedure restores shoulder mobility, with most movements returning to near-normal ranges after surgery for burn contractures.
Area of Science:
- Orthopedic Surgery
- Pediatric Burn Rehabilitation
- Biomechanics
Background:
- Children with upper extremity burns often develop axillary contractures, limiting arm movement.
- Axillary contractures can severely impact daily activities and quality of life.
Purpose of the Study:
- To evaluate the long-term effectiveness of surgical axillary contracture release on upper extremity motion.
- To assess functional recovery up to 7 years post-surgery using 3D motion analysis.
Main Methods:
- Ten subjects with 16 axillary contractures underwent 3D motion analysis before and after surgery.
- Functional tasks included high reach, hand to head, and hand to back pocket.
- Statistical analysis compared pre- and post-surgical movement patterns.
Main Results:
- Surgical release increased shoulder mobility and reduced compensatory movements.
- Improvements in upper extremity motion were sustained at long-term follow-up (mean 3 years).
- Most shoulder movements approached normal values, except for specific tasks like high reach and hand to back.
Conclusions:
- Axillary contracture release surgery offers significant short- and long-term benefits for shoulder function in pediatric burn patients.
- 3D motion analysis is a valuable tool for objectively measuring functional improvements after burn contracture release.
Abstract:
Children with upper extremity burns frequently develop axillary contractures that can restrict movement. Surgical axillary contracture release is performed to restore function. The purpose of this study is to determine the long-term effects (up to 7 years) of surgical axillary contracture release on upper extremity motion during simulated activities of daily living using three-dimensional motion analysis. Motion analysis was conducted on 10 subjects (9 males and 1 female; 16 axillary contractures; mean age 10 ± 3 years at baseline; mean TBSA burn 40 ± 15%) before, 1 year after, and 2 to 7 years (mean 3 ± 2 years) after axillary contracture release with split-thickness skin graft surgery. Movements were analyzed during three functional tasks including high reach (reaching overhead for an object), hand to head (combing hair), and hand to back pocket (toileting). Two-tailed paired t-tests were used to compare presurgical and postsurgical scores. Surgical release of the axillary contracture increased shoulder mobility and decreased compensatory movements. Improvements were maintained at long-term follow-up. All shoulder movements with the exception of shoulder flexion during the high reach task and shoulder abduction during the hand to back task were not significantly different than normal values at long-term follow-up. Axillary contracture release surgery improves shoulder function in the short and long term. Motion analysis is a modality that may prove valuable in objectively quantifying changes in movement patterns immediately and in subsequent years after burn injury.
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