In burn-related hand positioning, which joints are at greatest risk for flexion contracture if not properly supported by positioning?

• A. Wrist
• B. Metacarpophalangeal joints
• C. Proximal and distal interphalangeal joints
• D. Thumb

Answer: (C)

Preventing scar-related shortening after a hand burn hinges on keeping the finger joints extended to avoid contracture. The joints most at risk for flexion contracture if positioning isn’t maintained are the proximal and distal interphalangeal joints. When the hand is immobilized or not properly supported, the short flexor tendons and volar structures tend to shorten across these small joints, pulling them into a flexed posture and limiting extension. Using the intrinsic plus posture—wrist extended, MCP joints flexed, PIP and DIP joints extended, thumb abducted and opposed—helps lengthen the flexor and intrinsic mechanisms and keeps the IP joints from curling into flexion. While other joints can be affected, the PIP and DIP are the most vulnerable to flexion contractures if not properly supported.