Anti-contracture positioning

Burns can be incredibly painful and difficult to manage. The most comfortable position for the patient depends on the anatomical location of burns and follows the path of least resistance. By following these strategies, we can help to reduce pain and improve the patient's quality of life.

Anatomical location of burnComfortable position following the path of least resistanceAnti-contracture position – positioning and splinting strategy
MouthMicrostomiaYou may use a mouth splint, but this is often not very comfortable for the patient.
Neck-anteriorFlexion of the neckPlace the neck in extension. Do not place a pillow behind the neck. Ensure that the head is tilted back when in a seated position.
AxillaAdduction of the shoulderEnsure that the arms are abducted by 90 degrees, both when in a lying as well as seated position. Achieve this with the support of pillows or foam blocks.
ElbowFlexionPosition the elbow in extension. You can use a splint.
Wrist and hands: metacarpal-phalangeal joint (MCP), interphalangeal joint (IP)MCP – hyperextension
IP – flexion
Place the wrist in 30-40-degree extension, the MCPs in 60-70-degree flexion, the IP joints in extension, and the thumb in radial abduction.
Instructions for making a hand and wrist splint.
Groin/hipFlexion and adductionMake sure the legs are extended. Limit sitting and side lying. Do not place a pillow under the knees.
Knee – posterior foldFlexionPlace the knee in extension using an extension splint. Do not place a pillow under the knees.
Feet: ankle, metatarsal- phalangeal joint (MTP)Ankle – plantar flexion
MTP – dorsiflexion
Position the foot in a neutral position with dorsiflexion of the ankle at 90 degrees, using a pillow or splint for support.

Examples of anti-contracture positioning

Anti-contracture positioning

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