Trochanteric pressure in spinal cord injury.

Pressure-induced tissue breakdown is a frequent and life-threatening complication for individuals with spinal cord injury. These patients are frequently positioned on their sides to relieve back and sacral pressure while they are in bed. This position causes high trochanteric pressure with the potential for the development of pressure ulcers. In addition, the individual with a spinal cord injury has accompanying absent or diminished sensation, and therefore is not aware of the pressure overload. In this study the positions that will reduce the possibility that trochanteric ulcers will develop are identified. The Pressure Evaluation Pad (PEP), a pneumatic pressure monitoring system, has been used to study the effect of different leg positions on trochanteric pressure. The pressure under the right trochanter was monitored as the contralateral leg was positioned in various degrees of hip and knee flexion or extension. The procedure was repeated for the left trochanter. A study of 50 subjects demonstrated that a position of 30 degrees hip flexion and 35 degrees knee flexion (with lower leg behind midpoint of the body) produced lower contralateral trochanteric pressure than the traditional position of hip and knee flexion across the body. Additionally, thinner patients were found to have higher trochanteric pressure than average weight or obese subjects. Standardizing a method for the positioning of patients on their side can be a significant deterrent to the tissue erosion that greatly interferes with the rehabilitation process.