For second- and third-degree burns on the dorsal forearm and hand, which intervention would be appropriate?

For second- and third-degree burns on the dorsal forearm and hand, which intervention would be appropriate?

• A. Volar resting hand splint
• B. Volar intrinsic plus splint
• C. PROM of hand into a fist, then extension of all finger joints
• D. PROM of hand with each joint isolated

Answer: (B)

Positioning the hand to prevent contractures is the key idea here. After second- and third-degree burns on the dorsal forearm and hand, the goal is to preserve web spaces and maintain length of the intrinsic muscles so the hand can later function well. Placing the hand in intrinsic plus position — MCP joints in flexion while the PIP and DIP joints are extended — achieves that by lengthening the intrinsic muscles and stabilizing the arches of the hand. A splint that is worn on the volar surface and maintains this intrinsic plus alignment directly supports anti-deformity positioning during healing, protects newly formed tissue, and helps prevent clawing or web-space contractures as scarring matures. This approach is preferred over general resting splints or aggressive motion early in healing. A volar resting splint doesn’t consistently enforce the intrinsic plus alignment and thus is less protective against MCP flexion contractures. Active or passive ROM that attempts to form a fist or isolate each joint can stress healing tissues or promote undesirable scar patterns, especially soon after significant burns. The intrinsic plus volar splint provides a sustained, function-preserving posture that aligns with burn rehab principles for the hand.

Positioning the hand to prevent contractures is the key idea here. After second- and third-degree burns on the dorsal forearm and hand, the goal is to preserve web spaces and maintain length of the intrinsic muscles so the hand can later function well. Placing the hand in intrinsic plus position — MCP joints in flexion while the PIP and DIP joints are extended — achieves that by lengthening the intrinsic muscles and stabilizing the arches of the hand. A splint that is worn on the volar surface and maintains this intrinsic plus alignment directly supports anti-deformity positioning during healing, protects newly formed tissue, and helps prevent clawing or web-space contractures as scarring matures.

This approach is preferred over general resting splints or aggressive motion early in healing. A volar resting splint doesn’t consistently enforce the intrinsic plus alignment and thus is less protective against MCP flexion contractures. Active or passive ROM that attempts to form a fist or isolate each joint can stress healing tissues or promote undesirable scar patterns, especially soon after significant burns. The intrinsic plus volar splint provides a sustained, function-preserving posture that aligns with burn rehab principles for the hand.