Endgames Picture Quiz

An unusual burn

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f2856 (Published 15 May 2013) Cite this as: BMJ 2013;346:f2856
  1. C J Mitchell, core surgical trainee year 21,
  2. Z Ahmad, core surgical trainee year 21,
  3. M S Khan, consultant1
  1. 1Department of Burns, Plastic and Reconstructive Surgery, Salisbury District Hospital, Salisbury SP2 8BJ, UK
  1. Correspondence to: C J Mitchell, Department of Orthopaedics, Dorset County Hospital, Dorchester DT1 2JY, UK cjmitchell{at}doctors.org.uk

A 56 year old man presented with an injury to the radial aspect of his right wrist (figure). While undertaking mechanical repairs to his car the previous day his metal wrist watch had made contact with part of the electrical system. He felt immediate pain but did not implement any first aid measures or seek medical attention at the time of injury. Subsequent skin changes and discomfort at the periphery of the lesion prompted him to visit his general practitioner, who suspected an electrical burn and referred him to the local burns unit for assessment and management. He had no medical history of note. On examination the centre of the lesion had a leathery appearance, did not blanch on pressure, and was insensate.


  • 1 From the photograph, estimate the total body surface area and depth of this burn.

  • 2 How would you manage a patient presenting with an electrical burn?

  • 3 What complications can occur with an electrical burn?


1 From the photograph, estimate the total body surface area and depth of this burn

Short answer

The photograph shows a full thickness burn to the volar aspect of the wrist, total body surface area about 0.25%.

Long answer

Burn depth can be assessed using the four tests summarised in the table.1

View this table:

Assessing burn depth1

Several methods can be used to assess burn surface area as a percentage of total body surface area (TBSA), with the Lund and Browder burn charts being perhaps the most widely used. These allocate a percentage of TBSA to each part of the body and incorporate a conversion factor to compensate for …

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