Altering hip fractures
D. Stephen Robins, M.D.
Why the increasing attention to hip fractures? Is it that they are major traumatic events? Or that they are the most frequent fracture resulting from falls in long-term care settings? Or that around 350,000 occur in the U.S. every year? Or is it that the number is growing despite all the attention given to fall prevention over the past several decades?
Yes — on all counts. The real concern, however, is the severity of hip fracture outcomes —outcomes that are not just devastating, but truly life-altering. Indeed, how else can one describe an event following which one in two people are dead within a year and more than 60% are permanently dependent on others?
These appalling statistics have now been reaffirmed in a recent article in JAMA Internal Medicine documenting the sequelae of more than 60,000 hip fracture cases in nursing homes over a four-year period. The data confirm similar results from earlier studies that have sought to bring greater attention to the poor outcomes among those who have suffered such injuries.
“Fear of falling” is a syndrome familiar to the long-term care community. Yet despite the enormous efforts that have gone into fall-prevention over more than two decades, the number of hip fractures continues to rise. Long-term care facilities have invested in a plethora of special equipment, devices, materials, physical therapy programs, behavior and medication management protocols to reduce the frequency and severity of falls. But the incidence of hip fracture continues to rise.
A case for some serious head scratching? No, just some eye opening. The real problem is not the fall. It is the resulting fracture. So why limit the commitment of resources to prevent just the fall? How about some attention directly to the real problem — the fracture!
Certainly, strengthening bone through weight-bearing exercise and/or medication makes eminent sense. Stronger bones, fewer fractures. But what about protecting the bone from the force that breaks it? Why not place padding — a “hip protector”— between the hip and any hard surface against which it may fall for protection wherever and whenever the fall occurs. Intuitively obvious and very simple. Perhaps too simple?
Remember the NASA Shuttle disaster investigation? While everyone was looking at all manner of complex contributing factors and potentially alleviating procedures, something simple was overlooked — the materials used in the launching rockets. It took Richard Feinman's simple yet dramatic glass-of-cold-water demonstration of the brittle transformation of rubber O-ring gaskets in cold temperatures to attract the attention it deserved.
And that is also the case with hip protectors. At first they were so hard that they were too uncomfortable to wear during everyday activities, and even more so when trying to sleep at night. Softer materials were more comfortable, but at the expense of efficacy. Hybrid hard-soft materials followed, but problems with size, shape, and moisture buildup continued to result in poor wearer compliance. And if the hip protector is not worn, there goes hip protection. What to do?
An answer came from the field of giant slalom skiing. The challenge was finding a means of mitigating the impact force of marker flagposts against the skier's leading forearm using some form of highly effective armor that was also light-weight, malleable, and streamlined in a sport where speed and aerodynamics are all important.
Thus was born D3O®, a novel patented amalgam of non-Newtonian polymer materials that is lightweight and highly flexible at all times except when being suddenly struck with force, when it becomes instantaneously rigid and protective, only to relax as soon as the impact force is absorbed. Tested and proven during the 2006 Winter Olympics, D3O soon became the favored material in other fields where the combination of armor-like impact protection, flexibility, light weight, and comfort are prized—other extreme sports, military, and law enforcement. Other materials followed, but none matched the efficacy of D3O.
It was only a matter of time before D3O hip protectors arrived in the form of MedProtech's Fall-Safe® Hip Protectors. Better impact protection against sudden force than other hip protectors, their anatomically molded shape, flexibility, and compact size make them comfortable to wear, even at night while sleeping, thus mitigating the risk of fall-induced fractures when getting up at night. These factors were each designed to alleviate concerns over wearer compliance — a factor that is perhaps the greatest challenge in gaining widespread adoption of otherwise intuitively obvious hip protectors.
Like so much in good healthcare, listening to the problems and needs of patients and caregivers is often the signpost toward better outcomes. A new generation of hip protectors responding to the various shortfalls of earlier products is now promising to achieve the real goal—preventing the fracture, not just the fall.
D. Stephen Robin, M.D., is CEO of Medical Protection Technologies, distributor of the Fall-Safe® Hip Protector. Dr. Robins has championed numerous patient safety issues over his 35-year medical career in clinical practice, clinical research, and standards of practice development. He can be reached at firstname.lastname@example.org.