Rehabilitation of burns of the upper limb

The authors wish to document the experience of the Burns Unit, Singapore General Hospital in the management of burns of the upper limb. Fifty-six patients with post-burn deformity of the upper limb seen during a five year period (July 1978-July 1983) were reviewed. The cases were analysed and there were no significant differences in age, sex and race distribution. There were 8 axillary contractures, 9 elbow contractures, 10 wrist deformities and 56 hand deformities. Anterior axillary skin fold contracture was the commonest deformity occurring at the shoulder, whilst cubital contractures were mainly found on the lateral aspect of the elbow. The elbow was the commonest site for periarticular heterotopic calcification. Wrist deformities included hypertrophic scars and contractures and they were frequently found on the dorsum of the wrist. A classification of post-burn hand deformity has been described and this was based on the site of the original injury. Burns involving the dorsum of the hand/fingers were subclassified into two groups depending on whether the extensor tendon was involved. The prognosis was good when there was no tendon injury, but when the extensor tendons were involved, poorer hand function resulted and this was reflected by the number of secondary operative procedures required. Flexion contractures were the commonest deformity found on volar burns. When both surfaces were burned the prognosis depended upon the burns depth. Digital burns treated surgically had fewer residual contractures. The role of occupational therapy, scar control, splinting and secondary surgery in relation to the rehabilitation of the burned upper limb is discussed in some detail.(ABSTRACT TRUNCATED AT 250 WORDS)