Other bits of indirect evidence include the fact that frequent falls are not
a risk factor for proximal femoral fracture. On the other hand, neither is
osteoporosis (patients with PFF tend to be osteopenic but not more so than
controls- although this may be an 'overmatching' problem). Improved
treatment of osteoporosis certainly doesn't seem to have translated to the
expected reduction in PFF.
All a bit more complex than one would hope. And that's before starting on
the racial differences.
One paper that supports Rowley's view is Astrom et al. Physical activity in
women sustaining fracture of the neck of the femur. JBJS 69B, 1987 pp381 -
383- the original paper that showed that activity decreased rather than
increased the incidence of PFF, supporting the osteoporosis rather than
trauma view. This was the paper that swayed me until the papers favouring
hip pads came out in the early 90s.
On a related issue: if you suspect PFF but x-rays are negative, do you admit
the patient, discharge with or without review, CT, bone scan or what?
> Protectors may not prevent fractures, I agree, largely as the
> pelvis still
> undergoes a very rapid deceleration when it hits the floor,
> which is only
> minimally offset by the presence of the worn protector.
I think this also fits with the 'neurological' theory pretty well: a fall is
enough to break your hip with or without a protector. The way to prevent it
is to put your hands out (as most people do). How often have you seen a hand
injury in a patient with a PFF?
Matt Dunn
Warwick
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