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Vulvar Pressure Ulcer - An Inadvertent Complication of Thomas Splint: Case Report
Alok Chandra Agrawal1, Harshal Sakale1, Rakesh Dhaka1
1Department of Orthopaedics, All India Institute of Medical Sciences, Raipur, Chhatisgarh, India.
Journal of Orthopaedic Case Reports
|August 11, 2025
Summary
This case report details a rare vulvar pressure ulcer in a patient with sickle cell disease (HbSS) caused by a Thomas splint. It highlights the importance of monitoring immobilization devices to prevent pressure injuries in high-risk patients.
Area of Science:
- Medical Case Reports
- Wound Healing
- Hematology
Background:
- Pressure ulcers are common in immobilized patients, usually over bony prominences.
- Hematologic disorders like sickle cell disease increase risk for atypical pressure ulcer sites.
- External medical devices can cause pressure injuries in vulnerable individuals.
Observation:
- A 24-year-old woman with homozygous sickle cell disease (HbSS) developed a vulvar pressure ulcer.
- The ulcer was attributed to prolonged use of a Thomas splint for a femoral fracture.
- Necrosis was observed on the labia majora, diagnosed as a device-induced pressure ulcer.
Findings:
- The vulvar pressure ulcer was managed with conservative wound care, surgical debridement, and local advancement flaps.
- Orthopedic management was adjusted, including pressure-avoiding positioning for fracture fixation.
- Complete wound healing occurred within two weeks post-surgery.
Implications:
- Vulvar pressure ulcers are rare but underdiagnosed, especially in sickle cell disease patients.
- Regular inspection of pressure points and patient education are crucial for prevention.
- Multidisciplinary collaboration and careful monitoring of immobilization devices are vital to prevent pressure injuries.
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