Hip protectors and hip fractures

Age and Ageing, Nov, 1998 by Pirkko O. Jantti, Heikki J. Aho, Paivi-Liisa Maki-Jokela, Rauno J. Heikinheimo

SIR--In the March issue of Age and Ageing, two studies on the compliance of hip protectors were published [1, 2] together with an editorial [3]. We wish to report our findings [4].

We studied hip protectors in the municipal nursing home of Tampere, Finland. Seventy-two residents who could walk independently with or without a personal walking aid and had fallen previously were chosen for the study. Thirty-six were randomized by the closed-envelopes method to use the hip protectors; the other 36 formed the control group.

The hip protectors used were designed by one of us (R.J.H.) and marketed by Raunomo Oy (Hameenpuisto 1, FIN-33210 Tampere, Finland). They are made of cotton, resemble ladies' pants and have on each side a closed pocket, 20 cm high and 15 cm wide, enclosing a 2-cm-thick fragmented pad of closed-cell polyethylene foam. This pad is used in knee protectors by ice hockey players and has been tested with other hip protectors and found to be more effective than most other pads [5]. The hip protectors are of similar a design to those described by Villar et al. [1].

The hypothesis was that the hip protectors protect against fractures. Statistical testing was done with a one-tailed Fisher's exact test.

During the observation year, one hip fracture was reported in the users' group. Seven fractures and one dislocation of hip prosthesis occurred in the control group. The incidence of fractures was significantly higher in the control group (P = 0.028).

All but one of the fractures occurred after a fall, as did the dislocation of the prosthesis in the control group. Fractures per fall occurred in 1/197 of the users' group and 7/158 of the control group (P= 0.016).

Of the 19 subjects in the users' group who were still living in the nursing home at the end of the observation year, 13 were wearing the hip protectors, six were not. The remaining 17 subjects had either died or been permanently hospitalized. In the control group, only 11 subjects remained after 1 year which explains a greater number of falls in the hip protector group.

The six subjects out of 19 who stopped using hip protectors did so after wearing them for 1-9 months. They felt that the pants were hot and cumbersome, uncomfortable in bed and necessitated assistance in the toilet. Thirteen were still using them. They felt that they were warm, increased the feeling of safety, diminished the fear of falling and, in one subject, diminished an ache in the hips. Our results were similar to those of Villar et al. [1] who reported that one-third were using hip protectors after 3 months.

The staff were mostly positive about the hip protectors. They felt that the patients could be left to walk around more freely because the consequences of possible falls were less severe. This contrasts with the view of Parkkari et al. [2] who was afraid of overprotection of patients wearing hip protectors by the nursing staff. However, our results were in agreement with Parkkari et al. [2] in showing an increased need of help for some subjects in the toilet.

Hip protectors diminished the number of fractures in the hip region, in accordance with the results of Lauritzen [6]. Larger series are needed to establish their value. Compliance in wearing them is still a problem, but there is great inter-individual variability: some of the elderly ladies we studied had a very positive attitude, as had most nurses.

We believe that expanding use of hip protectors is the best and most economical means by which the hitherto ever-rising curve of the number of hip fractures can be turned downwards again.

[1.] Villar MTA, Hill P, Inskip H, Thompson P, Cooper C. Will elderly rest home residents wear hip protectors? Age Ageing 1998; 27: 195-8.

[2.] Parkkari J, Heikkila J, Kannus P. Acceptability and compliance with wearing energy-shunting hip protectors: a 6-month prospective follow-up in a Finnish nursing home. Age Ageing 1998; 27: 225-9.

[3.] Wilkinson TJ, Sainsbury R. Hip protectors. Age Ageing 1998; 27: 89.

[4.] Jantti P, Aho H, Maki-Jokela P. Turvahousut lonkanseudun murtumien ehkaisyssa (Hip protectors in prevention of the fractures in the hip region). Suomen Laakarilehti (J Finnish Med Assoc) 1996; 51: 3387-9.

[5.] Robinovitch SN, Hayes WC, McMahon TA. Energy-shunting hip padding system attenuates femoral impact force in a simulated fall. J Biomech Eng 1995; 117: 409-13.

[6.] Lauritzen JB, Petersen MM, Lund B. Effect of external hip protectors on hip fractures. Lancet 1993; 341: 11-3.

PIRKKO O. JANTTI
Hallituskatu II A 16, FIN-90100 Oulu, Finland
Fax: ( 358) 8 314 5207; E-mail: Pirkko.Jantti@ouka.fi

HEIKKI J. AHO
Department of Surgery, Hatanpaa Hospital, Tampere,
Finland

PAIVI-LIISA MAKI-JOKELA
Municipal Health Center, Tampere, Finland

RAUNO J. HEIKINHEIMO
Hameenpuisto I A 3, Tampere, Finland