From the Guidelines
Skin tenting in fractures appears as a visible deformity where the skin is pulled taut over a protruding bone fragment, creating a tent-like elevation of the skin surface. This occurs when a fractured bone end pushes against the skin from underneath without breaking through it. The affected skin typically looks stretched, shiny, and pale due to compromised blood supply. You may notice a triangular or peaked appearance of the skin directly over the fracture site, with the surrounding area potentially showing bruising or swelling. However, the provided evidence from the 2024 American Heart Association and American Red Cross guidelines for first aid 1 does not directly address the appearance of skin tenting in fractures, as it focuses on superficial wounds and abrasions. Despite the lack of direct evidence, in real-life clinical medicine, it is crucial to recognize skin tenting as a medical emergency requiring prompt treatment, as it indicates the fracture is close to becoming open (compound). The tented skin has reduced blood supply and may quickly necrose if left untreated, leading to infection and complications. Key characteristics of skin tenting include:
- A visible deformity with the skin pulled taut over a protruding bone fragment
- Stretched, shiny, and pale skin due to compromised blood supply
- A triangular or peaked appearance of the skin directly over the fracture site
- Potential bruising or swelling in the surrounding area Treatment involves urgent fracture reduction to relieve pressure on the skin, usually requiring orthopedic intervention. If you observe skin tenting, immobilize the area, avoid applying pressure to the tented region, and seek immediate medical attention to prevent skin breakdown and conversion to an open fracture.
From the Research
Appearance of Skin Tenting in Fractures
The appearance of skin tenting in fractures is characterized by:
- Skin dimpling or puckering, which is a rare occurrence after closed proximal humerus fractures 2
- Adherence of the dermal tissues to the underlying fracture fragment, resulting in skin puckering 3
- Skin tenting, which can lead to potential necrosis and necessitate early identification and prompt intervention 4
- Soft tissue interposition, which may be an important clinical sign indicating the need for internal fixation 5
Clinical Presentation
The clinical presentation of skin tenting in fractures can vary, but it is often associated with:
- Displaced or comminuted fractures, which can cause skin tenting or puckering 3, 6
- Underlying fractures, such as proximal humerus or tibial fractures, which can cause skin dimpling or puckering 2, 3
- Avulsion fractures, which can lead to skin tenting and potential necrosis 4
Importance of Early Identification
Early identification of skin tenting in fractures is crucial to prevent unwanted sequelae, such as: