Outcomes of end of range axilla splinting in children following burn injury

This thesis explores the prevalence and predictors of hypertrophic scarring and burn scar contracture in adults and children. It builds upon the limited evidence base of axilla splinting as an intervention, which may be a valuable treatment strategy to prevent axilla contracture following burn injury to this area. To date, two randomised control trials have been completed into the effectiveness of axilla splinting at 90° abduction post burn in adult cohorts. In children, the only available evidence is a case series of 23 children splinted between 90° and 160° abduction post burn, published in 1985. Anecdotally, at the Children’s Hospital at Westmead splinting the axilla at end of range post burn injury is well-tolerated with excellent range of movement outcomes. Therefore, a retrospective study was completed, exploring outcomes from January 2006 to July 2016 in 76 children. No child developed contracture of the axilla for the duration of the 2 year study follow-up with no adverse events recorded. Children who required splinting ≥60 days to maintain full axilla range of movement had a higher frequency of deep burn, flame mechanism and burn distribution involving the anterior trunk, flank and arm compared to children who were splinted <60 days. Early signs of contracture, considered to be loss of full axilla range of movement or significant banding, developed in 9 children within the first 3 months post burn. All 9 children responded to intensive therapy with restoration of full axilla range by 9 months post burn. End of range splinting may be a valuable intervention to maintain axilla range of movement in children following a burn to this area. To provide better evidence of the efficacy, feasibility and safety of end of range axilla splinting, comparison of this intervention to other types of axilla splinting practice or exercise only is recommended. Future research should also focus on improving reporting of the prevalence and predictors of burn scar contracture and hypertrophic scarring.