Serial Casting for Burns Contracture

Recruiting at 1 trial location

Overseen By Zoë Edger-Lacoursière, MSc

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: Centre hospitalier de l'Université de Montréal (CHUM)

Disqualifiers: Frostbite, Neurological disorder, Psychiatric, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 3

12 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests whether serial casting, a method involving a series of casts to gradually improve movement, can enhance movement and reduce scarring in individuals with serious arm burns. Participants will first receive one week of usual care. If no improvement occurs, they will begin the serial casting process. The study examines changes in joint movement, scar appearance, and participants' perception of arm function after treatment. Suitable candidates for this trial are adults with burn injuries that significantly limit arm movement. As an unphased trial, this study provides participants the chance to contribute to innovative research that could improve recovery options for burn injuries.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What prior data suggests that this serial casting intervention is safe for treating upper extremity burn contractures?

Research has shown that serial casting is a well-tolerated treatment for managing burn scar contractures, which refers to tightened skin, in adults. This process involves applying a series of casts to gradually stretch the skin and improve movement in the affected area. One study found that patients typically saw improvements in about 8.5 days, using an average of four new casts.

Importantly, these studies reported no serious side effects, suggesting that serial casting is a safe option for those dealing with tight skin from burns. Patients experienced better movement and less tightness in their scars. While researchers continue to study this treatment, the evidence so far supports its safety and effectiveness in helping people regain better movement and comfort after a burn injury. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about tailored serial casting for burns contracture because it offers a personalized approach that goes beyond the standard care of physical therapy and splinting. Unlike conventional methods that provide a one-size-fits-all solution, this intervention is customized to each patient's specific needs, potentially leading to more effective and faster recovery. By adjusting the cast to the patient's progress, this method ensures continuous and optimal stretching of the contracted area, which may result in improved mobility and reduced long-term complications.

What evidence suggests that serial casting is effective for treating upper extremity burn contractures?

Research has shown that serial casting, which participants in this trial will receive, can effectively improve joint movement in people with burn-related contractures. In a study with 15 patients, this method increased joint movement by an average of 54%. Other studies demonstrate that serial casting helps correct scar contractures when other treatments haven't worked. This approach provides noticeable improvements in mobility and flexibility for those with burn scars. Overall, serial casting offers a promising way to enhance movement in joints affected by burn injuries. ^{1 2 6 7 8}

Who Is on the Research Team?

Bernadette Nedelec, PhD

Principal Investigator

CRCHUM

Are You a Good Fit for This Trial?

This trial is for adult burn survivors who have lost more than 15% of their normal range of motion in joints like fingers, wrists, or elbows due to fire, flame, or scald burns. They must understand English or French and be able to follow the study's procedures. People with frostbite, chemical/electrical burns, certain psychiatric/cognitive disorders, neurological injuries from the burn, pre-existing conditions affecting movement, heterotopic ossification or when stretching is not advised cannot join.

Inclusion Criteria

I am 16 years old or older.

I am a burn survivor with significant movement loss in my hand or arm.

Have provided informed consent

Exclusion Criteria

I have been diagnosed with bone growth in abnormal places.

I cannot understand English or French.

I have had frostbite, chemical, or electrical burn injuries.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1 week

1 visit (in-person)

Usual Care

Participants receive one week of usual care to assess improvement in PROM

1 week

1 visit (in-person)

Serial Casting Treatment

Participants undergo tailored serial casting intervention if no improvement in PROM is observed

Tailored to patient's needs

Visits every Monday and Friday

Follow-up

Participants are monitored for changes in ROM, scar characteristics, and self-reported function 3 weeks after treatment cessation

3 weeks

1 visit (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Tailored serial casting intervention

Trial Overview The trial tests a tailored serial casting treatment on adults with upper extremity burn contractures. It compares one week of usual care followed by serial casting if there's no improvement in joint movement. The effects on scar characteristics and self-reported arm function are measured over time and compared against expected outcomes without this intervention.

How Is the Trial Designed?

Group I: Serial casted joint Experimental Treatment 1 Intervention

Tailored serial casting intervention following 1 week of usual care

Who Is Running the Clinical Trial?

Centre hospitalier de l'Université de Montréal (CHUM)

Lead Sponsor

Trials

389

Recruited

143,000+

Published Research Related to This Trial

Serial casting was successfully used to treat severe ankle plantar-flexion contractures in a child with a 49% total body surface area scald burn, improving the range of motion from 45 degrees of plantar flexion to neutral dorsiflexion over 2 months.

This case report suggests that serial casting can be an effective alternative to splinting and exercise for correcting contractures after burns, highlighting the need for further research to validate its efficacy in burn care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Serial casting of the lower extremity to correct contractures during the acute phase of burn care. Johnson, J., Silverberg, R.[2019]

In a study involving 15 patients with burn contractures, serial casting resulted in a significant mean increase of 54% in joint range of motion, demonstrating its effectiveness over traditional treatments.

The method was well-accepted by patients, had minimal complications, and successfully delayed or eliminated the need for surgical intervention, making it a practical option even for noncompliant patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Serial casting: a method for treating burn contractures. Bennett, GB., Helm, P., Purdue, GF., et al.[2006]

A systematic review of 25 studies involving children with Cerebral Palsy found that lower limb serial casting effectively improves ankle dorsiflexion range of motion, reduces hypertonicity, and enhances functional gait outcomes in the short to mid-term.

While serial casting combined with botulinum toxin type-A showed greater improvements in ankle dorsiflexion compared to casting alone, it did not significantly impact overall gross motor function, indicating that while beneficial, the clinical significance of the additional improvement may be limited.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effects of serial casting on lower limb function for children with Cerebral Palsy: a systematic review with meta-analysis. Milne, N., Miao, M., Beattie, E.[2021]

In a study involving seven patients with burn scar contractures, serial casting significantly improved joint range of motion from an average of 65.8° to 108.1° and reduced scar severity on the Modified Vancouver Scar Scale from 9.5 to 4.9.

The therapeutic effects were achieved within an average of 8.5 days and 4 new cast applications, suggesting that a standardized serial casting protocol could be developed for effective burn scar contracture rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Serial Casting as an Effective Method for Burn Scar Contracture Rehabilitation: A Case Series. Schetzsle, S., Lin, WWC., Purushothaman, P., et al.[2023]

In a study of 52 children under 3 years old with infantile idiopathic scoliosis, serial casting effectively corrected major spinal curves, with an average initial curve of 47° and significant improvements observed after treatment.

There was no significant difference in curve correction between those treated with pediatric hip spica tables and those treated with Risser or Mehta tables, indicating that the type of casting table used does not impact the effectiveness of the treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Outcomes for patients with infantile idiopathic scoliosis by casting table type. Marrache, M., Prasad, N., Thompson, GH., et al.[2022]

Serial casting is an effective and low-cost method for correcting burn scar contractures, providing consistent pressure and stretch to the affected tissue without the risk of patient removal.

In a case study of a 2-year-old with severe ankle contractures, serial casting was highlighted as a viable alternative to dynamic splinting, especially when patient compliance is a concern.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Serial casting as a technique to correct burn scar contractures. A case report. Ridgway, CL., Daugherty, MB., Warden, GD.[2019]

Citations

1. sciencedirect.com sciencedirect.com/science/article/pii/S2468912223000184

Serial casting for the improvement of joint contracture after ... We present two cases of a patients with scar contracture after burn wound treatment that improved in mobility and range of motion after serial casting.

2. withpower.com withpower.com/trial/phase-contracture-8-2022-13f9b

Serial Casting for Burns Contracture In a study involving 15 patients with burn contractures, serial casting resulted in a significant mean increase of 54% in joint range of motion, demonstrating ...

3. academic.oup.com academic.oup.com/jbcr/article/44/5/1062/7187020

Serial Casting as an Effective Method for Burn Scar ... Several studies have demonstrated serial casting to be effective in correcting scar contractures when traditional methods have failed or are not ...

4. utsouthwestern.elsevierpure.com utsouthwestern.elsevierpure.com/en/publications/serial-casting-a-method-for-treating-burn-contractures

Serial casting: A method for treating burn contractures Serial casting was used to increase the range of motion in 35 joints in 15 patients with burns. A mean increase of 54% was achieved. Casting provided immediate ...

5. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/37254900/

Serial Casting as an Effective Method for Burn Scar ... The current study aims to determine the optimal frequency of casting, potentially facilitating the development of a serial casting protocol.

6. researchgate.net researchgate.net/publication/371177213_Serial_Casting_as_an_Effective_Method_for_Burn_Scar_Contracture_Rehabilitation_A_Case_Series

Serial Casting as an Effective Method for Burn Scar ... This therapeutic effect was achieved within an average of 8.5 ± 3.7 days and 4.0 ± 2.2 new cast applications. Given the study findings, the ...

7. centerwatch.com centerwatch.com/clinical-trials/listings/NCT05425433/serial-casting-for-upper-extremity-burn-contractures

Serial Casting for Upper Extremity Burn Contractures The purpose of this study is to estimate the extent to which range of motion (AROM and PROM), scar characteristics and patient-reported upper- ...

8. shrinerschildrens.org shrinerschildrens.org/en/pediatric-care/serial-casting

Serial Casting Serial stretch casting can be a great method to bridge the gap between regular conservative treatments and surgical intervention.