Recurrence of post burn contractures of the elbow and shoulder joints: experience from a Ugandan hospital.
BACKGROUND
Recurrence of post-burn contractures, following inadequate management of post-burn contractures (PBC), is under reported. It is associated with multiple operations and an increased cost to patients and their families. The purpose of this study was to determine the frequency of recurrence of PBC of the shoulder and the elbow joint three months after surgical intervention and the associated risk- factors.


METHODS
This was a prospective cohort study conducted at CoRSU hospital from March 2012 to November 2014. All patients with PBC of the elbow and/or shoulder joint who consented to be in the study and met the inclusion criteria were enrolled. Data was collected using a pretested, coded questionnaire. A goniometer was used to measure the active range of motion of the involved joint. The measurements were recorded in degrees. The data was analysed with STATA version 12.1.


RESULTS
58 patients were enrolled consecutively in the study. There were 36 females and 22 males, with a female to male ratio of 1.6:1. The age range was 0.75-45 years, with a median age of 5 years. The average age at the time of injury was 3.4 years. The most common cause of initial burn injury was scalding. The average number of joints involved per patient was two. There was a high incidence of recurrence of PBC (52 %) among the participants. The shoulder had the highest frequency of recurrence at 67 %. The elbow joint had a frequency of recurrence of 27 %. All participants with both elbow and shoulder joint involvement had PBC recur. The risk factors for recurrence were flame burn (p = 0.007), duration of PBC of more than 1 year (p = 0.018), and incomplete release of the contracture (p = 0.002). The presence of keloids, hypertrophic scars, ulcers and the occurrence of complications at the contracture site were not associated with recurrence of PBC.


CONCLUSIONS
Recurrence of PBC of the elbow and shoulder joint is a common problem. The risk factors should be kept in mind during management of PBC to reduce the recurrence rate.
Mbarara University of Science and Technology, PO Box 1410, Mbarara, Uganda. balumukad@gmail.com.
Deo Darius
DD
Balumuka
CoRSU hospital, PO Box 46, Kisubi, Uganda.
George William
GW
Galiwango
College of Health Sciences School of Medicine, Makerere University, PO Box 7062, Kampala, Uganda.
Rose
R
Alenyo
D000293:Adolescent; D000328:Adult; D002056:Burns / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003286:Contracture / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D004551:Elbow Joint; D005260:Female; D005500:Follow-Up Studies; D006230:Hand Injuries / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures; D012008:Recurrence; D012307:Risk Factors; D012785:Shoulder Joint; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult