letter:a deep wound in left leg as a result of skin traction in 81-old-year woman with hip fracture...

LETTER Letter:A deep wound in left leg as a result of skin traction in 81-old-year woman with hip fracture in orthopaedic ward Dear Sirs Patients in orthopaedic ward are at risk of skin problems such as skin wounds. Skin tractions are used frequently in this ward with the aim to reduce pain in orthopaedic patients. Although skin traction has little side effects, but its use is not without risk. An 81-old-year woman with intertrochanteric fracture admitted to orthopaedic ward following fall from low altitude selected for this case report. The patient needs surgery for intertrochanteric fracture. The patient had past medical history of hypertension and ischaemic heart disease. For this reason, orthopaedic surgeons postponed surgery for 7 days to prepare the patient for surgery. In these 7 days, skin traction with 2·5 kg weight was attached to patient’s left foot. On the day of surgery in operation room, orthopaedic nurses who prapare patient for surgery reported 10-cm skin wound in the site of skin traction. Surgeons assessed the wound and reported that this wound is related to skin traction. They say that inappropriate attach- ment of skin traction to patient’s skin is cause of wound. The wound developed in medial proximal of left leg (Figures 1–3). Older patients who admitted to orthopaedic ward for surgery, usually, have several medical problems such as hypertension and ischaemic heart disease. To prepare these patients for surgery, usually they are hospitalised in orthopaedic ward for few days before surgery. In this time, they are at risk of skin problem such as pressure ulcer. Older patients have Figure 1. Figure 2. more fragile skin in comparison to other patients so their skin is not able to bear heavy traction and pressure. Poor skin blood circulation due to compromised cardiovascular system is another risk factor for skin problems © 2012 The Authors © 2012 Blackwell Publishing Ltd and Medicalhelplines.com Inc • International Wound Journal • doi: 10.1111/j.1742-481X.2012.00952.x 1

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$Page 1: Letter:A deep wound in left leg as a result of skin traction in 81-old-year woman with hip fracture in orthopaedic ward$

LETTER

Letter:A deep wound in leftleg as a result of skin tractionin 81-old-year woman withhip fracture in orthopaedicward

Dear SirsPatients in orthopaedic ward are at risk of

skin problems such as skin wounds. Skin trac-tions are used frequently in this ward withthe aim to reduce pain in orthopaedic patients.Although skin traction has little side effects,but its use is not without risk. An 81-old-yearwoman with intertrochanteric fracture admit-ted to orthopaedic ward following fall fromlow altitude selected for this case report. Thepatient needs surgery for intertrochanteric frac-ture. The patient had past medical history ofhypertension and ischaemic heart disease. Forthis reason, orthopaedic surgeons postponedsurgery for 7 days to prepare the patient forsurgery. In these 7 days, skin traction with2·5 kg weight was attached to patient’s leftfoot. On the day of surgery in operation room,orthopaedic nurses who prapare patient forsurgery reported 10-cm skin wound in the siteof skin traction. Surgeons assessed the woundand reported that this wound is related to skintraction. They say that inappropriate attach-ment of skin traction to patient’s skin is causeof wound. The wound developed in medialproximal of left leg (Figures 1–3).

Older patients who admitted to orthopaedicward for surgery, usually, have several medicalproblems such as hypertension and ischaemicheart disease. To prepare these patients forsurgery, usually they are hospitalised inorthopaedic ward for few days before surgery.In this time, they are at risk of skin problemsuch as pressure ulcer. Older patients have

Figure 1.

Figure 2.

more fragile skin in comparison to otherpatients so their skin is not able to bearheavy traction and pressure. Poor skin bloodcirculation due to compromised cardiovascularsystem is another risk factor for skin problems

$Page 2: Letter:A deep wound in left leg as a result of skin traction in 81-old-year woman with hip fracture in orthopaedic ward$

Letter

Figure 3.

in older patients. So nurses who are responsiblefor skin care should be aware and have moreattention to this group of patients. In thepresent case, we found that skin tractionscan cause deep skin wound. We suggest thatorthopaedic surgeon should not order skintraction with heavy weight in older patientswho admitted to orthopaedic ward few days

before surgery. Orthopaedic nurses also shouldbe aware that skin tractions can cause deep skinwound and assess the site of traction severaltimes a day for sign of skin wound.

Respectfully submitted,

Abbas Abdoli Tafti, MDOrthopedic Department, Kashani Hospital,Shahrekord University of Medical Sciences,

Shahrekord, Iran

Sanaz Sadat Sajadi, MDOrthopedic Department, Kashani Hospital,Shahrekord University of Medical Sciences,

Shahrekord, Iran

Hossein Rafiei, MScSchool of Nursing and Midwifery,

Shahrekord University of Medical Sciences,Shahrekord, Iran

[email protected]

Orthopaedic Trauma Pat Fleming Consultant Orthopaedic Surgeon

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By : Miss. Sana’a AL-Sulami. Definition of Traction Indication for Traction Classification of Traction Complications of Traction Assessment

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