Description

A 65-year-old man sustained a closed minimally displaced fracture of the right proximal humerus following a low-velocity road traffic accident. The alignment of the humeral head was satisfactory and the patient was treated conservatively with a polysling shoulder immobiliser (TalarMade, Universal Multi Arm Sling). He was reviewed in fracture clinic 2 weeks postinjury where the position and alignment of the fracture fragments remained satisfactory on check radiographs. Subsequent review at 4 weeks revealed a 10×2 cm² grade 3 pressure sore and surrounding erythema caused by the polysling strap (figure 1). The finding was incidental and he was completely asymptomatic to the effect of the strap on his neck. Following this, the strap was adjusted and additional padding was used to relieve pressure. The wound was managed by a district nurse with dressings which saw resolution of the pressure sore at 3 weeks (figure 2).

• Download figure
• Open in new tab
• Download powerpoint

Figure 1

Grade 3 pressure sore caused by the polysling strap.

• Download figure
• Open in new tab
• Download powerpoint

Figure 2

Resolution of the pressure sore at 3-week follow-up.

Polyslings are nylon slings that are commonly used to immobilise the shoulder and support the upper limb. Patients and healthcare professionals should be alerted to this potential complication and advised to assess the integrity of the skin and regularly inspect pressure areas. In this case, the patient was a healthy male with no additional risk factors for development of pressure sores. Risk assessments such as the Braden Score1 can be used to identify high-risk patients. Treatment includes relief of pressure, dressings, debridement and antibiotics in cases with superimposed infection but as always prevention is better than cure.2