title: Neglected post burns contracture of hand in children: Analysis of contributory socio-cultural factors and the impact of neglect on outcome.
abstract: BACKGROUND
  No study has ever evaluated the causes and effect of neglect on the outcome of post burns contractures of hand in children.
  
  
  METHODS
  66 hands in 61 children (mean age 12.22 years) with a mean neglect of 11.6 years (range 5-17 years) were assessed for the causes of neglect and the outcome of surgery. Average follow up was 6.6 years. The results were assessed in two groups of 5-10 years neglect as group I and >10 years neglect as group II.
  
  
  RESULTS
  In a total number of 134 contracted rays in 66 hands, the surgical procedures included local Z/V-Y flap (51 rays), cross finger flap (48 rays), full thickness graft (35 rays). Additional external fixator with a distracter was used in 3 patients treated at a delay of 14, 16 and 17 years. 50 (81.96%) patients belonged to rural and slum areas. The reasons for delayed treatment included poverty - 33 patients, lack of awareness of surgical treatment - 16 patients; and indifference of parents - 12 patients. 44 (72.13%) children were illiterates. With treatment the average DASH score improved from 65.10 to 36.90 (p < .000) and from 68.14 to 45.93 (p < .000) in group I and II respectively. The results were significantly superior in group I (p < .000).
  
  
  CONCLUSIONS
  The main factors for neglect in treatment of post burns contracture include poverty, lack of awareness and illiteracy. All the patients showed significant improvement in function after the surgery. Contractures with higher neglect had significantly inferior outcome.
authors.affiliation: Professor, Department of Orthopaedics, Government Medical College and Hospital, Sector 32, Chandigarh, India.
authors.forename: Ravi Kumar
authors.initials: RK
authors.lastname: Gupta
authors.affiliation: Senior Resident, Department of Orthopaedics, Government Medical College and Hospital, Sector 32, Chandigarh, India.
authors.forename: Nipun
authors.initials: N
authors.lastname: Jindal
authors.affiliation: Senior Resident, Department of Orthopaedics, Government Medical College and Hospital, Sector 32, Chandigarh, India.
authors.forename: Kulbhushan
authors.initials: K
authors.lastname: Kamboj
keywords: Hand contractures; Neglected; Pediatric; Post burn; Surgical outcome