Positioning
The positioning of the burn patient should begin immediately after the surgery and carried out until the scars are matured and all contractile forces cease (end) to exist.
Positioning should be designed for the specific individual's needs and be closely monitored and altered as the patient's medical status changes.
It should not compromise mobility and function.
Positioning must always be done in a way that it:
Reduces edema
Maintains joint alignment
Maintains soft tissues optimally elongated
Prevents contracture formation
Maintains ROM
Promotes wound healing
Relieves pressure
Protects joints, exposed tendons, and new grafts/flaps.
While selecting a position the therapist must always consider:
TBSA affected by the burn Depth of the burn Associated injuries Exposed tendons/joints
Patient's postoperative status.
Complications resulting from prolonged or improper positioning include:
Pressure ulcers
Nerve lesions
Decreased ROM
Joint malalignment.
General Guideline to Optimum Positioning for Different Body Segments:
1. Head- Head should be at 30° elevation.
2. Neck- Neck should be in the midline with 10-15° of extension (Fig. 1).
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Fig. 1: (A) Flexion contracture of neck, (B) Positioning of patient with burns of anterior neck |
3. Shoulder & Axilla- Shoulder should be positioned in 90° abduction with 15-20° horizontal adduction and slight external rotation(Fig. 2).
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| Fig. 2: (A) Axillary contracture, (B) Positioning of patient with burn of axilla |
4. Elbow- Elbow in 30° flexion with the forearm in mid supination is the optimum position from the functional point of view. Although flexion is the functional position.
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| Fig. 3 (A) flexion contracture (B) Extension splint |
5. Wrist and hand- Wrist in 0-30° extension, MCP joints in 70-90° flexion, and IP joints in full extension. The thumb should be positioned in a combination of palmar and radial abduction maintaining the first web space in a stretched position.
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| Fig. 4: Claw hand |
6. Hip joints & groin- Neutral flexion-extension and rotation, 10-15° hip abduction, and knee extension (Fig. 5).
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| Fig. 5: (A) Flexion contracture at hip, (B) Supine lying with extended legs and no pillow under knees |
7. Knee joints- Full knee extension The knee joints tend to develop contracture in flection.
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| Fig. 6: Flexion contracture of the knee can be avoided by keeping the legs extended in lying and sitting and by using knee extension splints |
8. Foot and ankle- The ankle joint should be positioned in neutral with the help of a foot-board or an L-splint. This position should be maintained while the patient is lying in the prone or supine position One must place a soft cushion under the calf and the heel while the patient is supine. Hard surfaces encourage venous stasis in the calf, leading to DVT and can cause heel pressure ulcers.
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| Fig. 7: Dorsal contracture at the ankle can be prevented by keeping the ankles at 90 degrees |
Related Topics:
- Role of Physiotherapy in Burn Injury
- Scar Management
- Splinting Guide for Burn Patient
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