Neglected post burns contracture of hand in children: Analysis of contributory socio-cultural factors and the impact of neglect on outcome

Abstract

Methods: 66 hands in 61 children (mean age 12.22 years) with a mean neglect of 11.6 years (range 5e17 years) were assessed for the causes of neglect and the outcome of surgery.Average follow up was 6.6 years. The results were assessed in two groups of 5e10 years neglect as group I and >10 years neglect as group II.Results: In a total number of 134 contracted rays in 66 hands, the surgical procedures included local Z/V-Y flap (51 rays), cross finger flap (48 rays), full thickness graft (35 rays).Additional external fixator with a distracter was used in 3 patients treated at a delay of 14, 16 and 17 years. 50 (81.96%) patients belonged to rural and slum areas. The reasons for delayed treatment included poverty e 33 patients, lack of awareness of surgical treatment e 16 patients; and indifference of parents e 12 patients. 44 (72.13%) children were illiterates. With treatment the average DASH score improved from 65.10 to 36.90 (p < .000) and from 68.14 to 45.93 (p < .000) in group I and II respectively. The results were significantly superior in group I (p < .000). Conclusion:The main factors for neglect in treatment of post burns contracture include poverty, lack of awareness and illiteracy. All the patients showed significant improvement in function after the surgery. Contractures with higher neglect had significantly inferior outcome.

Pattern of Post Burn Contracture of Hand in Eastern India

“…Gupta RK et al (2014) in their study also observed male female ratio of 1.03. [8] Our study is in concordance with the other studies. The preponderance of males over females may be due to the fact that males whether children or adults are more adventurous and more prone to injury and also that they are the bread earners of the family and thus morbidity affecting them is taken seriously and medical care is sorted, while the females are ignored.…”

“…Gupta RK et al [8] in their study also found that right hand was more commonly involved (60.65%). It is quite natural, since most of the people are right-handed and thus it has a greater chance of injury and thus contracture.…”

“…Others were students 30%, housewives 23.33%, crude and skilled manual workers 6.67% each. Gupta RK et al (2014) in their study observed that 72.13% children either never went to school or were drop outs. [8] These figures point out that improvement of socio-economic status and provisions of a good education will do a lot to safeguard against these disabling injuries.…”

“…Gupta RK et al (2014) in their study observed that 72.13% children either never went to school or were drop outs. [8] These figures point out that improvement of socio-economic status and provisions of a good education will do a lot to safeguard against these disabling injuries. The lower percentage of crude and skilled manual workers may be because they are the bread earners in the family and their disability will affect the whole family thus they are prompt to receive early treatment and follow advice.…”

Post burn flexion contracture of hand: a prospective study

“…The severity of a burn contracture depends on factors like the location and the depth of the burn, the time of surgical or nonsurgical treatment, post-injury splinting, hand therapy and scar care during the maturation process. 3 McCauley designed a severity rating for burn contractures of the hand by grading them I to IV. 4,5 Grade 1 and 2 contractures can be managed with typical therapy while grade III and IV contractures are further subcategorized as flexion, extension and mixed deformities.…”