Manitoba Health, Healthy Living & Seniors (MHHLS) supports reporting and learning from
patient safety events. The focus of a patient safety review is to closely look at the health care
system that surrounds and interacts with those giving and receiving care. The goal is to identify
risks to patient safety and recommend the most effective ways to minimize risk and improve the
delivery of healthcare.
Patient Safety Learning Advisory
Summary:
Keywords:
Device Name (if applicable):
Drug/Name/Fluid Name: (if applicable):
Type of Analysis: single event
Topic: Pressure Ulcer
A patient with peripheral vascular disease had Buck’s traction applied following the diagnosis of a
fractured hip for pain control and fracture stabilization.
When the traction was removed 26 hours later, reddened, circular, bruised areas were found in
area covered by the traction boot.
Despite treatment of the areas, pressure ulcers developed.
Amputation of the foot was needed approximately three months later.
Buck’s traction, pressure ulcers, amputation
