Development and Field-Testing of an Alternative Low-Cost Hand Splint for Burn Contracture

Introduction: Burn scar contractures remain a common source of disability in low- and middle-income countries and often require complex reconstructive operations to restore function to the patient.¹ Despite the high prevalence of burn scar contractures and subsequent release procedures though, patients often face tremendous barriers to adequate physical therapy and follow-up care, which results in relapse of the contracture following a release.^2,3 Static progressive splint mechanisms are well-described for this indication⁴, but these splints are cost-prohibitive or unavailable to patients in low- and middle-income countries. To that end, we describe our work to develop and test an alternative low-cost static progressive hand splint designed to prevent flexion recontracture in burn scar contracture release patients.

Methods: The splint was created through an iterative design-and-test process through collaboration with Stanford School of Medicine in the US, Kirtipur Hospital in Nepal, and Scheer Memorial Hospital in Nepal. Splints were given to 20 Nepali patients who underwent burn scar contracture release of the palmar hand and would not be able to return to the hospital for long-term physical therapy after their surgery. Patients were instructed to wear the splint at night for six months and to progressively extend the splint’s ratchet mechanism as tolerated. Patients were assessed for range of motion and hand function pre-operatively, one week post-operatively, and three months post-operatively.

Results: The initial prototype underwent multiple rounds of iterative design and feedback from patients for comfort, fit, and durability. Based on previous experience, patients who do not receive any physical therapy after contracture release procedures show an average decrease of 20^o ROM at six months after surgery, as compared to one week after surgery. Data at three-month follow-up shows that patients using this splint showed an average increase of 2^oof ROM improvement, as compared to one week after surgery.

Conclusion: We have created a hand splint that prevents flexion recontracture following burn scar contracture release of the hand. Ongoing work includes six-month follow-up to ensure maintenance of improved range of motion and testing in other indications including Dupuytren's contracture and stroke.