Deep XXXX following skin traction for hip fractures.

@entity1 @entity174 @entity16 @entity102 @entity260 @entity158 @entity272 @entity293 @entity413
INTRODUCTION: Elderly @entity1 who @entity174 their hips are susceptible to complications associated with bed rest before surgery. In some institutions a skin traction device is used in order to relieve @entity158 before surgery. The authors followed ten @entity1 who developed severe (deep) @entity272 and evaluated the relationship to the skin traction device. The need for use of a skin traction device is debated and the need for multidisciplinary treatment if this complication develops is emphasised. @entity1 AND METHODS: All @entity1 who had serious @entity272 between January and December 2000 were evaluated. A serious @entity272 was defined as any new and abrupt case of a full-thickness skin loss involving @entity16 of subcutaneous tissue, but not through the underlying fascia and not extending to underlying bone, tendon or joint capsule. Preoperative assessment including background illness and medications, the application of a skin traction device, the type of surgery that was performed, and complications were noted. RESULTS: Ten @entity1 (nine females and one male) aged 76-90 years met the criteria of serious @entity272 . The leading @entity102 was cardiovascular. Among these @entity1 there were intertrochanteric @entity174 (n = 5), subcapital @entity174 (n = 4) and a subtrochanteric @entity174 (n = 1). In all @entity1 a skin traction device was used. In seven out of the ten @entity1 the @entity272 occurred during or immediately after surgery. Other @entity260 included uncontrolled @entity413 levels (> 130 mg/dl during fasting) (two cases) and @entity293 (two cases). The @entity272 was treated with a daily wound care regimen by a trained nurse and included daily changing of wet dressings and application of Vaseline gauze. All @entity1 were allowed immediate ambulation after the surgery and were discharged 9-15 days after the surgery. Although improvement of the slough was noted in all @entity1 , none of them had fully recovered, and they had to continue treatment in outpatient clinics. DISCUSSION: The main goal of treatment in elderly @entity1 who fractured their hips is to return them to their previous activities of daily living. A skin traction device, although useful for many of the @entity1 , has the disadvantage of causing serious @entity272 . This complication can interfere with the normal curve of rehabilitation and cause prolonged hospital stay. Whenever this complication is expected, the application of the skin traction device should be avoided. Moreover, careful handling of the @entity1 by physicians, physiotherapists and nurses is mandatory. If this complication develops, vigorous multidisciplinary care is recommended.
