External hip protectors.

Abstract

We wish to present the first reported proximal femoral fracture occurring in a patient wearing external hip protectors. These hip protectors consist of elliptical plastic shields sewn into modified underpants and are of the design used by Lauritzen and colleagues in the 1993 randomized trial of the use of external hip protectors in older people resident in a Danish nursing home.1 This study suggested that a reduction in the rate of hip fracture of 53% could be achieved, with hip fractures only occurring in patients who were not wearing the protectors at the time of a fall onto their hip. These findings indicated that external hip protectors have the potential to be of major benefit to older people at high risk of proximal femoral fracture. Hence, we are conducting randomized trials of use of external hip protectors in both community-dwelling older people and those in residential care. In these studies the first adverse event occurred in an 89-year-old woman with Alzheimer's Disease of moderate severity. After surgical treatment for a proximal femoral fracture on the right side, the patient commenced wearing external hip protectors in the rehabilitation ward. During this admission she fell twice during one night while attempting to go to the toilet. She was wearing the hip protectors at the time of the falls, but they appear to have been around her knees (perhaps in readiness to go the toilet) rather than in correct position over the greater trochanters. We believe the incorrect position of the underwear contributed to the falls. Following both falls the patient was able to walk and did not indicate pain. A precautionary X-ray showed a Garden II subcapital fracture of the left femur. This was surgically treated with a compression screw and plate. Our current hip protector research experience with older women is that most are unwilling to wear the protectors at night. However, it has been our practice to encourage women at very high risk of fracture to wear the hip protectors at night as they continue to be at risk at this time. This episode illustrates the need for caution with this strategy. We have observed another fracture occurring in a patient wearing external hip protectors. An 81-year-old woman fell outside her home while wearing hip protectors and sustained a fracture of the inferior pubic ramus, which was not displaced, as well as soft tissue injuries to the shoulder and chest wall. This patient had a hemiarthroplasty (following a subcapital femoral fracture) on the same side as the pelvic fracture. The patient commented that the hip protectors were properly in place at the time of the fall and that the protector impacted with the ground. Given the other injuries, some force was taken by the shoulder. After 14 days hospitalization the patient regained sufficient mobility to return home. She continues to use hip protectors. There have been no previous pelvic fractures reported by users of external hip protectors.2 Although the injury sustained by the above patient was significant, its severity was less than a proximal femoral or femoral shaft fracture. We conclude that the use of hip protectors was of benefit to this patient.