Introduction: Burn injuries of the hand are common but lead to devastating scar contractures and poor functional outcomes if not treated promptly and properly. The purposes of this report are to characterize a pattern of injury that results from thermal burn to the thumb-index (first) web space and dorsal hand, and to describe a new treatment protocol designed to maximize clinical results after such accidents.

Methods: This prospective study was limited to patients who sustained second-degree burns to the index-thumb web space and dorsal surfaces of the fingers when flaming cooking grease or oil splashed onto their hands. A new treatment protocol was initiated that emphasized daily hydrotherapy sessions. Silver sulfadiazine cream was kept on the burns between hydrotherapy sessions, and patients participated in a graduated, supervised rehabilitation program. Subjective and objective data were obtained at follow-up.

Results: Patient demographic analysis revealed all patients were female, between the ages of 38-56 years, and each injured her dominant hand. At a minimum of 12 months follow-up, all had good to excellent results (Mayo scale) and DASH scores indicated patients considered themselves to have minimum disability (mean score 17). One patient lacked 10 degrees flexion of the MP joint; the others recovered full motion compared to the opposite hand. None developed functionally significant contractures.

Discussion: Thermal injuries are the most common subset of burns to the hand. The specific pattern of injury and its mechanism described here often are under appreciated. Splash-pattern burns on the dorsal aspect of the first web space from flaming cooking-related substances, such as grease, are injuries that might be prevented by appropriate patient education, and highlights the need to develop protective devices on cooking utensils to minimize the chance for such injuries to occur. When those burns do occur, more aggressive treatment can lead to improved outcomes and more satisfied patients, as this study demonstrates.