Abstract
Hip fractures in older adults, which often lead to lasting impairments and an increased risk of mortality, are a major public health concern. Hip fracture risk is multi-factorial, affected by the risk of falling, the load acting on the femur, and the load the femur can withstand. This study investigates the influence of impact direction on hip fracture risk and hip protector efficacy. We simulated falls for 4 subjects, in 7 different impact directions (15° and 30° anterior, lateral, and 15°, 30°, 60°, and 90° posterior) at two different impact velocities (2.1 and 3.1 m/s), all with and without hip protector, using previously validated biofidelic finite element models. We found the highest number of fractures and highest fragility ratios in lateral and 15° posterior impacts. The hip protector attenuated femur forces by 23–49 % for slim subjects under impact directions that resulted in fractures (30° anterior to 30° posterior). The hip protector prevented all fractures (6/6) for 2.1 m/s impacts, but only 10% of fractures for 3.1 m/s impacts. Our results provide evidence that, regarding hip fracture risk, posterior-lateral impacts are as dangerous as lateral impacts, and they support the efficacy of soft-shell hip protectors for anterior- and posterior-lateral impacts.
Highlights
IntroductionHip fractures in older adults are associated with long periods of hospitalization, chronic impairment, co-morbidities, depression, decreased mobility, and reduced quality of life.[23,48] hip fracture
Hip fractures in older adults are associated with long periods of hospitalization, chronic impairment, co-morbidities, depression, decreased mobility, and reduced quality of life.[23,48] hip fractureAddress correspondence to Ingmar Fleps, Institute for Biomechanics, ETH-Zurich, Zurich, Switzerland
No femoral fractures were observed in the 60° and 90° posterior impacts, pelvic fractures were seen for subject H1389
Summary
Hip fractures in older adults are associated with long periods of hospitalization, chronic impairment, co-morbidities, depression, decreased mobility, and reduced quality of life.[23,48] hip fracture. Electronic mail: flepsi@ bu.edu patients experience increased mortality rate within the first year after a fracture has occurred.[23,36] With the elderly population growing, the socio-economic cost associated with hip fractures is expected to grow .[4,48]. The majority of hip fractures occur as a consequence of falls from standing height or lower.[36,39]. The load that the femur is subjected to depends on factors specific for the faller, such as soft tissue thickness over the greater trochanter,[3,44] stiffness,[42] and shape,[9] and on biomechanical aspects of the fall such as impact velocity, impact region, and impact direction.[6,14,28,40,50,51]
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