Assessing the safety and effectiveness of hip protectors

Hip protectors are used in the preventive management of older people who are at risk of fracturing their hip after a fall. However, nurses have little guidance about which type is the most appropriate for particular patients. This article highlights the different designs available and their mechanical performance was assessed by the authors using a purpose-built impact rig. Problems with compliance and issues about tissue viability are discussed and the article also contains a risk assessment tool to help nurses decide on which is the most suitable type of hip protector to use.     

老年髋部骨折后对侧髋部的再骨折

背景:老年髋部骨折后发生对侧髋部再骨折数目在逐年增加。目的:阐述老年髋部骨折后对侧髋部再骨折的临床特征,提高对再次对侧髋部骨折的认识。方法:于2001-01/2011-07对老年单侧髋部骨折患者567例和老年再发对侧髋部骨折患者30例,分析再发对侧骨折病例的发生率、骨折类型、年龄、性别、骨密度、骨质疏松、再骨折时间间隔和合并症。结果与结论:单侧髋部骨折与再发对侧髋部骨折患者年龄、性别比例和骨密度值接近。老年髋部骨折患者中,对侧髋部再骨折发生率为5.0%。转子间骨折再发对侧髋部骨折率高于股骨颈骨折再发对侧髋部骨折率(P=0.018)。再发对侧骨折组骨质疏松发生率高于单侧骨折组(P=0.032)。初次骨折后发生对侧骨折的间隔时间平均2.4年,其中1年发生的最多,占40.1%。提示老年髋部骨折患者对侧髋部再骨折发生率较高,对于伴有骨质疏松和合并症的转子间骨折患者在术后1年内应加强预防,防止对侧髋部骨折的再次发生。     

老年髋部骨折后对侧髋部的再骨折

背景：老年髋部骨折后发生对侧髋部再骨折数目在逐年增加。目的：阐述老年髋部骨折后对侧髋部再骨折的临床特征,提高对再次对侧髋部骨折的认识。方法：于2001-01/2011-07对老年单侧髋部骨折患者567例和老年再发对侧髋部骨折患者30例,分析再发对侧骨折病例的发生率、骨折类型、年龄、性别、骨密度、骨质疏松、再骨折时间间隔和合并症。结果与结论：单侧髋部骨折与再发对侧髋部骨折患者年龄、性别比例和骨密度值接近。老年髋部骨折患者中,对侧髋部再骨折发生率为5.0%。转子间骨折再发对侧髋部骨折率高于股骨颈骨折再发对侧髋部骨折率（P=0.018）。再发对侧骨折组骨质疏松发生率高于单侧骨折组（P=0.032）。初次骨折后发生对侧骨折的间隔时间平均2.4年,其中1年发生的最多,占40.1%。提示老年髋部骨折患者对侧髋部再骨折发生率较高,对于伴有骨质疏松和合并症的转子间骨折患者在术后1年内应加强预防,防止对侧髋部骨折的再次发生。     

Missed hip fractures.

From a series of 825 consecutive admissions with a hip fracture there were 16 cases in which the diagnosis was not made when the patient was initially seen in hospital. The reason for the delay in diagnosis was failure to correctly interpret X-rays in 10 cases and failure to X-ray the hip in three cases. The fracture was radiologically invisible in only three patients. Fifteen of the fractures were initially undisplaced, but as a consequence of the delay in diagnosis displacement occurred in 75% of subcapital fractures and all extracapsular fractures.     

Long-term follow-up of hip fractures.

Hip fractures on 117 patients treated surgically and followed up for an average of 10.2 months are reviewed. Among the parameters analyzed were complications, mortality, clinical follow-up by the operating surgeon, and the ability to ambulate after surgery. Postoperative surgical complications occurred in 36% and medical complications in 18% of the patients. Mortality was 25% within the first year after surgery. Sixty-one percent of the patients returned at least once to the surgeon's office for follow-up; only 38% were followed for more than six months. In the surviving patients who were good ambulators before hip fracture, 60% to 70% became good ambulators postoperatively. Only 20% to 30% of the surviving patients who were poor ambulators preoperatively ever walked again.     

Modern methods of treating hip fractures

Contemporary surgical and anaesthetic methods should enable almost all hip fractures to be treated surgically. Many of the implants used for the internal fixation of hip fractures or the arthroplasties for replacement of the hip joint have been in use for over 50 years. Marked improvements in surgical technique have led to lower fracture and surgical complications. Undisplaced intracapsular fractures and displaced fractures in the younger patient are best treated by internal fixation. For the elderly with a displaced intracapsular fracture then hemiarthroplasty is generally used. There is insufficient evidence that total hip replacements or bipolar hemiarthroplasties have any advantage over the more traditional designs. For trochanteric fractures the sliding hip screw remains the implant of choice, although the newer intramedullary nails are valuable for more specific fracture types and their use will become more common. Following surgery almost all patients should be allowed to mobilize without any restrictions on weight bearing or hip movements.     

Modern methods of treating hip fractures

Contemporary surgical and anaesthetic methods should enable almost all hip fractures to be treated surgically. Many of the implants used for the internal fixation of hip fractures or the arthroplasties for replacement of the hip joint have been in use for over 50 years. Marked improvements in surgical technique have led to lower fracture and surgical complications. Undisplaced intracapsular fractures and displaced fractures in the younger patient are best treated by internal fixation. For the elderly with a displaced intracapsular fracture then hemiarthroplasty is generally used. There is insufficient evidence that total hip replacements or bipolar hemiarthroplasties have any advantage over the more traditional designs. For trochanteric fractures the sliding hip screw remains the implant of choice, although the newer intramedullary nails are valuable for more specific fracture types and their use will become more common. Following surgery almost all patients should be allowed to mobilize without any restrictions on weight bearing or hip movements.     

Modern methods of treating hip fractures

Contemporary surgical and anaesthetic methods should enable almost all hip fractures to be treated surgically. Many of the implants used for the internal fixation of hip fractures or the arthroplasties for replacement of the hip joint have been in use for over 50 years. Marked improvements in surgical technique have led to lower fracture and surgical complications. Undisplaced intracapsular fractures and displaced fractures in the younger patient are best treated by internal fixation. For the elderly with a displaced intracapsular fracture then hemiarthroplasty is generally used. There is insufficient evidence that total hip replacements or bipolar hemiarthroplasties have any advantage over the more traditional designs. For trochanteric fractures the sliding hip screw remains the implant of choice, although the newer intramedullary nails are valuable for more specific fracture types and their use will become more common. Following surgery almost all patients should be allowed to mobilize without any restrictions on weight bearing or hip movements.     

Determinants of staff commitment to hip protectors in long-term care: A cross-sectional survey

BackgroundIf worn, certain models of hip protectors are highly effective at preventing hip fractures from falls in residents of long-term care, but modest acceptance and adherence have limited the effectiveness of hip protectors. Residents of long-term care are more likely to accept the initial offer of hip protectors and to adhere to recommendations concerning the use of hip protectors when staff are committed to supporting the application of hip protectors. Yet, we know very little about the nature of and factors associated with staff commitment to hip protectors in long-term care.ObjectiveTo identify factors associated with staff commitment to hip protectors in long-term care.DesignA cross-sectional survey.SettingThirteen long-term care homes (total beds = 1816) from a single regional health district in British Columbia, Canada.ParticipantsA convenience sample of 535 paid staff who worked most of their time (>50% of work hours) at a participating long-term care home, for at least one month, and for at least 8 h per week. We excluded six (1.1%) respondents who were unaware of hip protectors. Of the remaining 529 respondents, 90% were female and 55% were health care assistants.MethodsRespondents completed the Commitment to Hip Protectors Index to indicate their commitment to hip protectors. We used Bayesian Model Averaging logistic regression to model staff commitment as a function of personal variables, experiences with hip protectors, intraorganizational communication and influence, and organizational context.ResultsStaff commitment was negatively related to organizational tenure >20 years (posterior probability = 97%; logistic regression coefficient = −0.28; 95% confidence interval = −0.48, −0.08), and awareness of a padded hip fracture (100%; −0.57; −0.69, −0.44). Staff commitment was positively related to the existence of a champion of hip protectors within the home (100%; 0.24; 0.17, 0.31), perceived quality of intraorganizational communication (100%; 0.04; 0.02, 0.05), extent of mutual respect between residents and staff and perceived contribution to quality of life of the residents they serve (100%; 0.10; 0.05, 0.15), and frequency of transformational leadership practices by respondents’ primary supervisors (100%; 0.01; 0.01, 0.02).ConclusionsWe provide novel insight into the factors governing staff commitment to hip protectors in long-term care. Targeting of these factors could improve acceptance and adherence with hip protectors, thereby contributing to enhanced effectiveness of hip protectors to prevent hip fractures in long-term care.