Where is the place for splinting in burns?
Despite splinting being common place amongst paediatric burns intervention, there is debate as to the quality and consistency of evidence informing this practice and its translation into indicators for splinting and wear regimes.
Clinical practice is based on available evidence that at times is inconclusive. Some snapshots of this evidence indicate:
- Early, effective, and consistent use of positioning devices and splints is recommended for successful management of burn scar contracture [3].
- Sustained stretches are often more tolerable to the patient and more effective for producing tissue lengthening [1].
- When compared with multimodal approach (massage, exercises, pressure) those treated with progressive treatment (static or dynamic splints, serial casting) required significantly fewer days to correct the contracture [6].
- splinting may contribute to contractile forces increasing and thus increase contracture [7]. Thus, new positioning options such as kinesiotaping may become increasingly important as further evidence is developed.
Despite the ongoing clinical discussion, splinting remains an intervention used internationally within specialist burns units and requires an individualised and team approach as to the intended regime, design and rationale for use.
If applied incorrectly, splinting can cause harm to a child including nerve compression, discomfort or altered sensation, pressure areas, circulation compromise if anchored too tightly or shearing/friction to a skin graft. Splints need applied correctly with knowledge of underlying anatomy, protection of bony prominences, consideration to underlying skin integrity and be compatible with treatment interventions (ie burns dressings, ports, IV lines etc). Regular monitoring of splinting is required to minimise risk to the child and to ensure splinting is continuing to provide the desired outcome.
