Post-Burn Contractures: Gradual Correction with the Ilizarov Method

Burn scars tighten as they heal. Across a joint – knee, elbow, wrist, fingers, ankle or neck – this can pull the joint into a bent position that slowly becomes fixed (a contracture). Over months and years, muscles, tendons, nerves, vessels and even the joint capsule shorten too. A contracture can make walking, using the hand or self-care very difficult.

Why gradual correction?

In long-standing, severe contractures, straightening the joint at once in surgery can overstretch nerves and blood vessels and leave large gaps in the skin. The Ilizarov method corrects the joint slowly over weeks with a hinged external frame. Skin, scar, vessels and nerves adapt as they are stretched – the same principle that allows bone lengthening (sometimes called distraction histiogenesis). This can reduce or avoid the need for very large skin grafts or flaps, and lowers the risk to nerves.

Who may benefit

• Severe, long-standing contractures of the knee, elbow, ankle, wrist or fingers
• Contractures where skin quality is too poor for one-stage release
• Contractures with bone or joint changes that also need correction
• Patients whose previous releases recurred

Treatment plan

1. Assessment with the plastic surgery team: skin, scar maturity, nerves, vessels, joint X-rays
2. Surgery: a hinged frame is applied around the joint; limited scar releases or tendon lengthening may be added
3. Gradual correction: daily small adjustments over several weeks, with regular nerve and circulation checks
4. Skin cover: remaining skin gaps, if any, are treated with grafts or flaps, often much smaller than would otherwise be needed
5. Holding: the frame is kept until the new position is stable
6. After frame removal: splints (often worn at night for months), physiotherapy, scar management with pressure garments and silicone, and regular review

Possible complications

Pin-site infection, temporary nerve stretch symptoms, joint stiffness, skin breakdown, and recurrence if splinting and exercises are not continued, especially in growing children. Some joints damaged by years of contracture will not regain full movement, but a straighter, more useful position is usually achievable.

Team care

Burn contracture reconstruction is shared between the orthopaedic, plastic surgery and rehabilitation teams. At Ortho World Hajipur, our plastic and reconstructive surgeons work alongside the limb reconstruction team.

Frequently asked questions

How long after the burn can this be done? Usually once the scars have matured and the skin is healed. Timing is individual.

Will the contracture come back? It can, so long-term splinting, exercise and scar care are part of treatment.