With a burned hand, the burn is the short story and the contracture is the long one.
Skin that heals by scarring shortens as it matures — and a shortening sheet of scar across the front of a wrist or a finger pulls that joint closed, permanently, over months.
Which is why the splint you’re given on day three matters more than almost anything else that happens, and why it’s the thing people abandon first.
Depth decides everything
Superficial. Red, painful, no blisters. Heals in days without scarring.
Superficial partial thickness. Blisters, wet, very painful, blanches when pressed. Usually heals in about two weeks with minimal scarring.
Deep partial thickness. Mottled, less painful than it should be, slow to blanch. Three weeks or more to heal — and anything taking more than about three weeks to close scars significantly. That’s the threshold that predicts contracture.
Full thickness. White, leathery or charred, and painless because the nerve endings have gone. Needs grafting.
A burn that doesn’t hurt is worse than one that does. Pain means the nerve endings survived.
First aid, which genuinely changes depth
- Cool running water, 20 minutes. Not five. Twenty. It works up to about three hours after the burn and it can reduce the final depth
- Remove rings immediately, before the swelling arrives
- Cling film, loosely laid, not wrapped — clean, non-adherent, and lets the wound be seen
- No ice, no butter, no toothpaste, no creams
- Elevate
Hands are one of the areas that warrant specialist burns assessment almost regardless of size, alongside face, feet and genitals. A 2% burn on a hand is not a minor burn.
The position of the splint is the whole game
Scar pulls joints toward the position they rest in. So the hand is splinted in the position OPPOSITE to where the contracture would take it.
That means knuckles bent, middle and end joints straight, thumb out, wrist slightly extended — the safe position described in the finger joints article. It is the position that feels least comfortable, and it is the one that preserves the hand.
The web spaces need specific attention too, because scar between the fingers webs them together and quietly costs you span and grip.
The timeline
- Days 0 to 3 — wound care, depth assessment, splinting begins, elevation
- Week 1 to 3 — movement between dressing changes. Every day of stillness costs range
- Week 3 onwards — once healed, scar management starts: silicone, massage, and pressure garments worn most of the day
- Month 1 to 6 — the scar is at its most active. Red, raised, itchy and TIGHTENING. This is the window in which splinting and stretching change the outcome
- Month 6 to 18 — maturation. The scar fades and softens. What it has pulled into by then is largely what you keep. See scar management
People stop wearing the pressure garment around month four, because the wound looks healed. Month four is the middle of the fight, not the end of it.
Get specialist review if
- Any burn to the hand, deep or circumferential, or involving a joint crease
- A burn that hasn’t healed at three weeks
- The burn goes all the way round a finger or the hand — swelling inside a circle of dead skin can cut off circulation
- Chemical or electrical burns, whatever they look like
- The scar is tightening, and a joint is losing range month on month
For the splint used, see the first web space splint and the resting hand splint.
The burn heals in weeks. The scar keeps pulling for a year, and it pulls in whatever direction you let the hand rest.
Every article on this site is written using the Closing Window Method: name the window your condition runs on, find where you are in it, and act while it’s still open.