Ischial tuberosity
Specific risks
Ischial tuberosity pressure injuries are caused by sitting. Ischial tuberosities take most of the seated body weight (in neutral sitting) on a flat firm surface, as they are the lowest contact point of the pelvis.
Surfaces and activities that cause increased pressure, shear, and friction to the ischial tuberosities can include:
- cushions
- any other seating surfaces such as sports chairs, car seats, flooring/ground surfaces, other chairs (e.g. dining, lounge or outdoor), tub transfer benches or static shower chairs
- transfers
- poor posture especially pelvic obliquity and/or scoliosis
- inadequate frequency or quality of pressure relief
- tight clothing, incontinence pads or underwear seams
- muscle wasting or weight loss
- mattresses especially if spending prolonged periods in bed
Moisture and microclimate changes from heat and humidity, incontinence, or clothing. This can increase the risk of rashes or blemishes on the buttocks that can deteriorate with sitting.
Frequent use of the dominant hand such as working on the computer or driving the power wheelchair can increase the risk of the pelvis dropping on this side.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.
- Sitting on a commode may be possible after review. This is advantageous with providing stretch to the healing area, continuing the bowel routine to prevent incontinence, and allowing hygiene to the wound and skin.
- A postural assessment is required to review any pelvic obliquity or scoliosis. An interim assessment can be attended to when on bed rest.
- Optimal lying positions are flat in supine with knees flexed up, prone lying or side-lying.
- Sitting in a wheelchair may be possible with custom seating. Rehabilitation Engineering Centre, Surgical Treatment and Rehabilitation Service (STARS) can be consulted for advice.
The contact details are:
email: STARS_REHABENG@health.qld.gov.au or
phone: (07) 3647 6070
Stage 3 or 4 pressure injuries may require a surgical consult.
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.