Lateral Aspect of the Greater Trochanter

Specific risks

Most likely to occur when side-lying with increased risk from:

  • wasting of the lower limbs
  • impaired sensation
  • impaired mobility
  • a poor-quality mattress
  • bottoming out between air cells on the mattress
  • lying on incontinence sheets or pads
  • moisture from sweating or incontinence

The lateral aspect of the greater trochanter can touch the tyres or side guards in a manual or power-drive wheelchair. This can be exacerbated by weight gain or external rotation of the legs.

Pelvic obliquity can cause ‘drifting’ of the pelvis to one side of the wheelchair.

Poor transfer technique:

  • an ill-fitting, wet or textured sling can cause pressure, shear and friction
  • side-ways ‘drag’ during horizontal transfers can cause shear and friction
  • These areas should be assessed by palpating for ‘boggy’, soft, or tender areas.

Management of breakdown

  • Review and identify causative factors such as the mattress, cushion, showering aids, other seated surfaces, transfers, clothing, muscle bulk, care routines and continence management.
  • Explore the possibility of continuing to sit and offload the wound. This can include:
    • assessment of the wound position, including surfaces in contact with the wound bed or any potential underlying sinus when sitting. Any suspicion that pressure is being applied to an underlying cavity, requires complete bed rest.
    • postural assessment in lying and sitting
    • a review of the suitability of the wheelchair dimensions
  • Assess bed positioning and mattress quality and appropriateness. Supine positioning, prone lying and side-lying off the wound are the best options.
  • If hoisting, assess whether the sling contacts the wound.
  • Stage 3 or 4 pressure injuries may require a surgical consult.

Contact the following services within the Queensland Spinal Cord Injuries Service to refer a person for a review of a wound:

For urgent consultation

On-call Consultant Spinal Injuries Unit,
Princess Alexandra Hospital Ipswich Road,
Woolloongabba, Queensland.
Switch: (07) 3176 2111
Ask for the SIU Registrar on business days or an on-call SIU Consultant during after-hours for the Spinal Injuries Unit.

For a review at the Spinal Injuries Unit outpatient department

Referrals can be faxed through the central intake hub on 1300 364 248.

To link with community services

Contact Spinal Outreach Team at 3176 9507 or spot@health.qld.gov.au

Check out other pressure injury locations and learn how to manage them.