Burn Orthosis

The anti-deformity static

progressive hand orthoses
 1 Orthosis for Burned Hand

 Section 1: The effect of burns

 Hypertrophic scarring: Burn injuries may result in

hypertrophic (or keloid) scarring. It’s an abnormal
response to wound healing in which extra
connective tissue forms within the original wound
area, Hypertrophic scars are an exaggerated
response of the body’s healing process. becoming
raised, red, rigid and painful

 Contracture: As scars mature they also contract

or shorten. If the burn crosses over joints this
leads to reduced Range of motion and
functional impairment

 Syndactyly or web space deformity: When

the entire digital web space has been
destroyed by burn scarring and there is a
contracture of the volar aspect of the web
as well as the dorsum leading to the loss of
tissue between digits and subsequent
fusion. It can affect both the function and
appearance of the hand

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 2 Orthosis for Burned Hand

 Section 2: How do orthoses help in burns rehabilitation?

1. Maintaining constant pressure over the scar.

 This has the following effects:

-Decrease scar formation by reducing the amount of oxygen and blood flow within the scar
tissue which slows the influx of collagen.

-Speeds up the scar maturation and encourages reorientation of collagen fibers into uniform,
parallel patterns as opposed to the disorganized pattern seen in untreated scars.

-Protect the skin graft and keep it still while it is healing.

-Restore range of motion of a joint by stretching the skin.

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2. Prevention of contracture
When scars contract they take the shortest route possible which means they may cause
contractures across natural concavities and joints such as the neck, knee, elbow and armpit. If
untreated this may cause reduced range of motion and functional problems. Burns orthoses are
used to maintain a consistent, gentle stretch over the area, helping to remodel scar tissue as it
forms and maintain anatomical contours, thereby preventing excessive scar contracture.

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 3 Orthosis for Burned Hand

 Section 2.1: The difference between standard orthoses and those

specialized for burns:

According to the American Society of Hand Therapists, An orthosis is defined by as a

single device that is rigid or semi-rigid. Used to support a weak or deformed body
part, or restrict or eliminate motion of a body part. In burn care, the term "splint" is
more commonly used than "orthotic," although both terms and the devices they
represent are almost synonymous.

Splints serve various purposes, including the protection of fragile wounds or newly
grafted burn wounds. They are also utilized to position joints to sustain achieved
Range of Motion (ROM) or as dynamic devices to apply gentle prolonged stretch for
increasing ROM.

However, it's crucial to note that splints cannot substitute active exercise; if a patient
is consistently splinted in a specific position, contractures may still develop even in
desirable positions.

Static splints, on the other hand, are specifically designed to maintain a chosen
position by immobilizing the joint.

Dynamic splints are crafted to actively exercise or mobilize a joint. Additionally, a

splint can augment the pressure exerted on a scar through a pressure support
mechanism.

However, if any unusual pain (aside from mild tissue elongation or stretch
discomfort), sensory impairment, or wound maceration is experienced at the splint
site, it should be promptly removed, and the fit should be readjusted.

Let us take a look at the resting hand orthoses when it’s designed as an intervention
for burns and otherwise to compare the design principles.
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 4 Orthosis for Burned Hand

 Resting hand orthoses immobilize the wrist, thumb,

and metacarpophalangeal (MCP) joints to provide rest
and reduce inflammation. The proximal interphalangeal
(PIP) and distal interphalangeal (DIP) joints are free to
move for functional tasks. This design is often used for
rheumatoid arthritis.

 When used for burns it’s is modified to optimally

position the hand in an intrinsic-plus position after a burn
injury. Burn resting hand orthoses usually maintain the
wrist in a position of 20 to 30 degrees extension, while
the MCP joints are flexed at 60 to 80 degrees. The PIP
and DIP joints are kept in full extension, and the thumb is
positioned midway between radial and palmar abduction
with padding between each digit to prevent the soft
tissue from sticking together.

 Section 3: The Anti-deformity static progressive burned hand orthoses

project:

Burn injuries involving the hand commonly result in contracture deformity Roughly
39% of burns involve the upper extremity The hands account for less than 5% of
total body surface area, and although hand burns do not often play a major role in
mortality, they are important factors in successful reintegration into society and
professional life after discharge from the hospital.

Splints are important in the management of a burned hand, and the type of splint
used depends on the location of the burn and the anticipated deformity.

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 5 Orthosis for Burned Hand

 Dorsal surface hand burns, the splint should position the hand in the angle of
anti-deformity, also referred to as intrinsic plus position.

 Palmar surface burns should be positioned in a palmar extension splint.

The static progressive orthosis is employed to address significant joint
contractures following burns.

 Section 3.1: Why use the shark fin?

Crafting a custom static progressive splint can be costly and time-consuming.

To ease splint construction, we introduced three-dimensional (3D)-printed “shark
fin”-shaped device works as a static progressive orthosis for the hand rehabilitation.

 Section 3.2: Design

The hand rehabilitation orthosis, shaped like a wedge or shark fin, features:

1. Contoured base: for forearm placement

2. Straps: for secure fastening.
3. Undercuts: allow for the attachment of a static line,
4. Finger ring: aids in positioning and stretching.

 Section 3.3: Uses

This device effectively addresses contractures of

metacarpophalangeal (MCP) and interphalangeal
(IP) joints, providing steady force to alleviate
limitations caused by conditions like burns or
injuries. By maintaining proper torque and
alignment, it facilitates joint mobility and
rehabilitation.

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 6 Orthosis for Burned Hand

It is also effective in addressing scar contractures

near the thumb, which can impede extension and
opposition movements. By applying a steady
force to the thumb, it gradually enhances its
range of motion and functionality. Similar to its
use for MCP and IP joint contractures, the device
is secured over a splint on the palm and forearm,
with the static line adjusted to provide proper
torque perpendicular to the thumb. This approach
aids in overcoming limitations in thumb mobility
caused by scar contractures, enabling improved
dexterity and grasp in daily activities.

It can also be utilized to mobilize the radiocarpal

joint effectively. By attaching the device to a splint
positioned on the dorsal side of the forearm and
securing the strip to the palm, a progressive pulling
force is applied to enhance wrist extension. Initially,
the strip is fixed at the upper position of the device's
wedge to ensure a consistent stretch angle. As
improvement occurs, the strip is gradually moved
down the wedge to maintain adequate torque and
further increase range of motion (ROM) in wrist
extension. Similarly, if positioned on the volar side
of the forearm, the device facilitates increased ROM
in wrist flexion through a

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 7 Orthosis for Burned Hand

 Section 4: CAD/CAM process of the Shark Fin

-The 3D printed shark fin was designed and printed using The CAD/CAM software
Solidworks.

 Section 4.1 Measurements:

1. Overall height: 10 cm, catering to the average length and thickness of the
forearm (8-5 cm long 4-5

cm thick)

2. Strap insert width: 6cm as a wider strap is proportionate to better harnessing

3. Distance between each strap level: 0.8-1 cm

These measurements were implemented as a 2D sketch in solidworks, then later

converted into 3D

 Section 4.2: Printing

The shark fin is set to be printed with the following
specifications:

1. Material: PLA was chosen due to its strength to

weight ration being sufficient for this task

2. Infill: Set to about 70% to strike a balance between

rigidness and weight

3. Infill pattern: Quarter cubic to provide strength without

adding too much weight

4. Machine used: FDM as it specializes in printed PLA

filaments

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