Hip protector

A hip protector is a specialized form of pants or underwear containing pads (either hard or soft) along the outside of each hip/leg, designed to prevent hip fractures following a fall. They are most commonly used in elderly individuals who have a high risk of falls and hip fractures (for example, due to history of a previous fall and underlying osteoporosis).[1]

Most hip fractures follow an impact due to a lateral fall.[2] The pads are located over the trochanters, the bony extrusions of the hip region.

Hip protectors are either of the "crash helmet type" or "energy-absorbing type". The "crash helmet type" distributes impacts into the surrounding soft tissue, while the "energy-absorbing type" is made of a compressible material and diminishes the force of impact. Both of these systems aim to reduce the focused force beneath an estimated fracture threshold.[1][3]

Several different commercially available hip protectors exist, such as the Safehip (Tytex A/S, Ikast, Denmark), the AHIP Protector (Astrotech, Vienna, Austria) and the KPH hip protector (HRA Pharma, Paris, France).[1] The former has been used in most clinical trials.[4] Hip protectors have the advantage of having no important adverse effects.[5]

Clinical studies of their effectiveness have shown conflicting results.[6] A systematic review from 2006 found that that hip protectors are only marginally effective for preventing hip fracture among nursing home residents, and not effective among community dwelling elderly individuals.[5] A recent randomized trial was discontinued because it failed to demonstrate any benefit.[6] A Bayesian meta-analysis showed a decreased risk of hip fractures in elderly nursing home residents.[7]

However, acceptance and long-term compliance towards them is quite low,[5] mainly because of discomfort, dislike of their appearance by the person wearing it, and disagreement about fracture risk.[8] A recent study showed that hip protectors' design and mechanical properties vary drastically among commercially available hip protectors.[9]

Footnotes

  1. ^ a b c Holzer, G; Holzer, LA (2007). "Hip protectors and prevention of hip fractures in older persons". Geriatrics 62 (8): 15–20. PMID 17668960. 
  2. ^ Lauritzen, JB (1996). "Hip fractures: incidence, risk factors, energy absorption, and prevention". Bone 18 (1 Suppl): 65S–75S. doi:10.1016/8756-3282(95)00382-7. PMID 8717550. 
  3. ^ Holzer, LA; Holzer, G (2007). "Design: A neglected factor in medicine". McGill journal of medicine : MJM : an international forum for the advancement of medical sciences by students 10 (1): 3. PMC 2323546. PMID 18523599. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2323546. 
  4. ^ Lin, JT; Lane, JM (2008). "Nonpharmacologic management of osteoporosis to minimize fracture risk". Nature clinical practice. Rheumatology 4 (1): 20–5. doi:10.1038/ncprheum0702. PMID 18172445. 
  5. ^ a b c Parker, MJ; Gillespie, WJ; Gillespie, LD (2006). "Effectiveness of hip protectors for preventing hip fractures in elderly people: systematic review". BMJ (Clinical research ed.) 332 (7541): 571–4. doi:10.1136/bmj.38753.375324.7C. PMC 1397761. PMID 16513687. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1397761. 
  6. ^ a b Kiel, DP; Magaziner, J; Zimmerman, S; Ball, L; Barton, BA; Brown, KM; Stone, JP; Dewkett, D et al. (2007). "et al.. Efficacy of a hip protector to prevent hip fracture in nursing home residents: the HIP PRO randomized controlled trial". JAMA 298 (4): 413–22. doi:10.1001/jama.298.4.413. PMID 17652295. 
  7. ^ Sawka, AM; Boulos, P; Beattie, K; Papaioannou, A; Gafni, A; Cranney, A; Hanley, DA; Adachi, JD et al. (2007). "Hip protectors decrease hip fracture risk in elderly nursing home residents: a Bayesian meta-analysis". J Clin Epidemiol 60 (4): 336–44. doi:10.1016/j.jclinepi.2006.07.006. PMID 17346606. 
  8. ^ Patel, S; Ogunremi, L; Chinappen, U (2003). "Acceptability and compliance with hip protectors in community-dwelling women at high risk of hip fracture". Rheumatology (Oxford, England) 42 (6): 769–72. doi:10.1093/rheumatology/keg215. PMID 12730537. 
  9. ^ Holzer, LA; Von Skrbensky, G; Holzer, G (2009). "Mechanical testing of different hip protectors according to a European Standard". Injury 40 (11): 1172–5. doi:10.1016/j.injury.2009.02.005. PMID 19524913.