Dear Editors,
Patients in the orthopaedic ward are at risk of 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 few side effects, its use is not without risk. An 81‐old‐year woman with intertrochanteric fracture admitted to the orthopaedic ward following a fall from low altitude was selected for this case report. The patient required surgery for intertrochanteric fracture. She 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. During these 7 days, skin traction with 2·5 kg weight was attached to the patient's left foot. On the day of surgery in the operation room, orthopaedic nurses who prepared the patient for surgery reported a 10‐cm skin wound at the site of skin traction. Surgeons assessed the wound and reported that it was related to skin traction and that inappropriate attachment of skin traction to patient's skin was the cause. The wound developed in the medial proximal portion of left leg (1, 2, 3).
Figure 1.
Figure 2.
Figure 3.
Older patients who are admitted to the 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 the orthopaedic ward for few days before surgery. During this time, they are at risk of skin problems such as pressure ulcers. Older patients have 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 in older patients. Therefore the nurses who are responsible for skin care should be aware of this and pay more attention to this group of patients. In the present case, we found that skin tractions could cause deep skin wounds. We suggest that orthopaedic surgeons should refrain from ordering skin tractions with heavy weight in older patients admitted to the orthopaedic ward a few days before surgery. Orthopaedic nurses also should be aware that skin tractions can cause deep skin wounds and assess the site of traction several times a day for signs of skin wound.
Abbas Abdoli Tafti, MD
Orthopedic Department, Kashani Hospital, Shahrekord
University of Medical Sciences, Shahrekord, Iran
Sanaz Sadat Sajadi, MD
Orthopedic Department, Kashani Hospital, Shahrekord
University of Medical Sciences, Shahrekord, Iran
Hossein Rafiei, MSc
School of Nursing and Midwifery,
Shahrekord University of Medical Sciences, Shahrekord, Iran
hosseinrafiei21@yahoo.com