Outcomes of early use of an end of range axilla orthotic in children following burn injury.

Scar contracture is a significant complication of burn injury. This study aimed to describe outcomes of early axilla orthotic use at end of range abduction in children, following a burn to the axilla region. A retrospective review of 76 children (mean age 3.9 years (SD 3.6)) treated at a tertiary children's hospital from 2006-2016 was conducted. No child developed axilla contracture for the duration of the 2-year study follow-up with no adverse events recorded. If orthotic use was ceased <60 days post burn it was considered not an essential intervention to maintain range of movement, leaving 49 children using the orthotic 60 days. Compared to the children who ceased orthotic use in <60 days, children who required the orthotic 60 days had a significantly higher frequency of deep dermal burn (59% vs 25%, p=0.01), flame mechanism (25% vs 5%, p=0.03) and burn injury distribution involving the anterior trunk, flank and arm (18% vs 3%, p=0.03). Early signs of contracture, considered loss of full axilla range or significant banding, developed in 9 children within 3 months post burn. With intensive therapy all returned to full axilla range by 9 months post burn. Children with skin tension at end of range shoulder movement at the 1-month clinical assessment were 11 times more likely to develop early signs of contracture (95% CI 1.9-62.1, p=0.007). Intensive orthotic use at end of range shoulder abduction in children with axilla burns is well tolerated. When undertaken with ongoing therapist review, full axilla range can be maintained.