‫‪Hip and Thigh burn‬‬

‫‪By‬‬

‫وليد صالح الدين محمد حسين‬

‫بحث شهر يونيو‬

‫(‪)case study‬‬
‫‪Hip and thigh burn research‬‬

‫‪Under supervision‬‬
‫‪DR/ Mahmoud Elkholi‬‬

‫‪By‬‬
‫ريمون ناجح عطاهللا‪1-‬‬
‫مصطفي نصر‪2-‬‬
‫وليد صالح الدين‪3-‬‬
‫مارتينا بطرس ميالد‪4-‬‬
‫أم السعد حسين عبد الباسط‪5-‬‬
‫نجالء سعد وجدي‪6-‬‬
‫مارينا نشأت‪7-‬‬
‫كيرلس رفعت‪8-‬‬
‫مادونا ميالد‪9-‬‬
‫كارولين مرقص‪10-‬‬
‫(بحث شهر يونيو)‬
‫(‪)case study‬‬
A 40-year-old womanis going to cooking food in the kitchen of
her home, The gas was leaking from the gas tube , when she
turn the light on ,explosion occureed leading to a burn in the
hip and thigh area .. She was taken to the hospital and this
.burning was controlled

Assessment
should include (problem list)
1/amount of tissue injury (agent of burn and degree of burn)
2/Muscle flexbility
3/Sensory assessment
4/Edema circumfence
5/scar assessment
6/ROM ASSESMENT
7\palpation
1/amount of tissue injury (agent of burn and degree of burn )

by examining her we found

1/black and even waxy white flesh.
2/Blisters and redness occurs typically around the edge of the
burns
3/ a hard, leathery eschar that is painless and black, white,
or cherr patient has no feeling in the burned area. No
epidermal y red
4/ patient has no feeling in the burned area.
This is an extremely severe burn injury and requires immediate
medical care.
2/Flexibility special tests assessment :
1:thomas Test :
is used to measure the flexibility of the hip flexors, which
includes the iliopsoas muscle group, the rectus femoris,
pectineus, gracillis as well as the tensor fascia latae and the
sartorius
The patient should be supine on the examination table,
maximally flex both knees, using both arms to ensure that the
lumbar spine is flexed and flat on the table and avoids a
posterior tilt of the pelvis.
The patient then lowers the tested limb toward the table,
whilst the contralateral hip and knee is still held in maximal
flexion to stabilize the pelvis and flatten out the lumbar
lordosis. The length of the iliopsoas is measured by the angle of
the hip flexion
The Thomas test is negative when the subject's lower back and
the sacrum is able to remain on the table. The hip can make a
10° posterior tilt or a 10° hip extension. The knee must be able
to make a 90° flexion.
The test is positive when:
Subject is unable to maintain their lower back and sacrum
against the table
Hip has a large posterior tilt or hip extension greater than 15°
Knee unable to meet more than 80° flexion
which in our case
we found the test is positive due to contracure occur which
lead to place the limb in flextion postion due to burn and scar
formation
Ober's Test :
The Ober's test evaluates a tight, contracted or inflamed Tensor
Fasciae Latae (TFL) and Iliotibial band (ITB)
Test position :
The patient should be in side-lying with the affected side up.
Bottom knee and hip should be flexed to flatten the lumbar
curve.
Stand behind the patient and firmly stabilize the pelvis/greater
trochanter to prevent movement in any direction.
Grasp the distal end of the patient’s affected leg with your
other hand and flex the leg to a right angle at the knee
Test:
Extend and abduct the hip joint.
Slowly lower the leg toward the table -adduct hip- until motion
is restricted.
Ensure that the hip does not internally rotate and flex during
the test and the pelvis must be stabilized. As allowing the thigh
to drop in flexion and internal rotation would 'give in' to the
tight TFL and not accurately test the length.
Results:
If the ITB is normal, the leg will adduct with the thigh dropping
down slightly below the horizontal and the patient won't
experience any pain; in this case, the test is called negative.
If the ITB is tight, the leg would remain in the abducted position
,and the patient would experience lateral knee pain

.in this case, the test is called positive

in our case we will find

the test is negative and we cannot perform test well due to
tightness in the adductors dueto deformity occureed due to
burn occur
 3/Sensory assessment :
since these burn penetrate the dermis ,nerve endings have
been destroyed ,and the patient has no feeling in the burned
area .no epidermial or dermal appendages remain .thus , these
wounds must heal by re-epithelialization from the wound
edges .deep thermal and full thickness burns reguire eschar
excision with skin grafting to heal the wounds in timely fashion
4/edema circumfence
by round measurement
we use sterilized tape measurement as an objective method to
record changes in edema and compression with othe side
in our case we will found change in edema circumfence by
increasing in size
5-Scar evaluation :
For the assessment of (hypertrophic) scars various tools are
currently available. The Vancouver Scar Scale (VSS)
a validated subjective scale . Another
subjective and valid scale, the Patient and Observer Assessment
Scale (POSAS) , consists of a patient and an observer part to
evaluate the scar . Besides the use of an assess-
ment scale to define hypertrophic scarring, we now believe
that the area of elevation in a burn scar is also of significance
6- ROM :
METHODS :
The subjects' active ROM at each joint was measured using a
goniometer and inclinometer with a standardized technique.
Multiple planes of motion (ie, flexion/extension) were
investigated at each joint
Joint muscle action in each plane is assigned a normal ROM
based on physical examination conventions.
Furthermore, if more than one muscle action was limited at a
joint, the severity of the most impaired muscle action at that
joint was considered to represent the severity of contracture at
that joint.
Table 1.
Range of motion severity ratings by joint muscle action
(degrees)

7- Palpation :
During palpation, the examiner checks:
Vascular System – Distal pulses, capillary refill

Physical therapy management

Principles of Physiotherapy in Care of Burn Patients the
therapist begins immediately after
burn and is carried over the entire period of the recovery till
final rehabilitation of the patient
.
Physiotherapy primarily involves:
• Positioning
• Splinting

Hip splinting included

Hip spica Abduction splint Spreader bar
Contraindications
Global instability •
Patients at risk for an anterior dislocation •
Chronic dislocation •
Positioning Anti-contracture positioning must start from day
one and may continue for many months post-injury. It applies
to all patients
.whether they have been skin grafted or not
Hip joints—appropriate position: Neutral flexion-extension and
,rotation
hip abduction and knee extension °15–11
In patients with no ventilatory problems the prone Position
facilitates hip as well as knee extension
.Knee joints—appropriate position: Full knee extension
The ankle joint: should be positioned in neutral with the help of
a foot board or a L splint. This position Should be maintained
while the patient is lying in the prone or supine
Position
Place soft cushion under the calf and the heel while the patient
Is supine
ROM (Range of Motion) Exercise Passive ROM
-Exercise in order to prevent contracture, to main
.Tain and promote the ROM, and to prevent edema
Also proceed gradually to the active-assistive These ROM
exercises should be enforced days after having the burn 5–2
Ankle-foot pumping: done
.Actively or passively at two hourly intervals to prevent DVT
Stretching exercises
In conjunction with a splinting regime appears to help elongate
.the scar tissue maintaining ROM
So we do stretching for hip Flexor mainly iliopsoas muscle
Electrotherapy modalities
Ultrasound therapy 1
It have great effect in burn cases
Promot the formation of granulation Accelerated of
reepithimalizaton
It reduce wound infection It improve scare pliability
Application
In contacte
By using coupling media as gel pad and applied on edges of
wound
: Parameters
Frequancy 1 MHz Intensity 0,5_1.00w/cm
Duration: size of the affected zone in the the hip and thigh in
cm2 / ultra sound head.. the result in minutes