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Pekka Kannus - One of the best experts on this subject based on the ideXlab platform.

  • energy shunting external Hip Protector attenuates the peak femoral impact force below the theoretical fracture threshold an in vitro biomechanical study under falling conditions of thel elderly
    Journal of Bone and Mineral Research, 2009
    Co-Authors: M Jari D Parkkari, Jussi Heikkila, J Poutala, Harri Sievanen, Pekka Kannus, I Vuori
    Abstract:

    The first objective of this study was to design a Hip Protector that would effectively attenuate and shunt away from the greater trochanter the impact energies created in typical falls of the elderly. As the shock absorption material, the Protector included the 12 mm-thick Plastazote, which was found to be the most efficient energy-absorbing material in our previous in vitro biomechanical tests. With an anatomically designed semiflexible outer shield of the Protector (high density polyethylene), the impact surface was increased and the impact energy shunted away from the greater trochanter. In the second phase of the study, we determined the force attenuation capacity of this device in realistic (in vitro) falling conditions of the elderly. With the impact force of 6940 N used (a typical Hip impact force measured in in vitro falling tests), the trochanteric soft tissue (25 mm-thick polyethylene foam) attenuated the peak femoral impact force to 5590 N and the tested Protector to 1040 N. In the second series of this experiment, the peak femoral impact force was set to be so high (13,130 N) that the Protector, if effective, should prevent the Hip fracture in almost all cases. The trochanteric soft tissue attenuated this peak impact force to 10,400 N and the tested Protector to 1810 N. Thus, the force received by the proximal femur still remained clearly below 4170 N, the average force required to fracture in vitro the proximal femur of the elderly in a fall loading configuration. In conclusion, our test results suggest that an anatomically designed energy-shunting and energy-absorbing Hip Protector can provide an effective impact force attenuation in typical falling conditions of the elderly. However, the efficacy of the Protector in the prevention of Hip fractures can only be evaluated in randomized clinical trials.

  • energy shunting external Hip Protector attenuates the peak femoral impact force below the theoretical fracture threshold an in vitro biomechanical study under falling conditions of thel elderly
    Journal of Bone and Mineral Research, 2009
    Co-Authors: M Jari D Parkkari, Jussi Heikkila, J Poutala, Harri Sievanen, Pekka Kannus, I Vuori
    Abstract:

    The first objective of this study was to design a Hip Protector that would effectively attenuate and shunt away from the greater trochanter the impact energies created in typical falls of the elderly. As the shock absorption material, the Protector included the 12 mm-thick Plastazote, which was found to be the most efficient energy-absorbing material in our previous in vitro biomechanical tests. With an anatomically designed semiflexible outer shield of the Protector (high density polyethylene), the impact surface was increased and the impact energy shunted away from the greater trochanter. In the second phase of the study, we determined the force attenuation capacity of this device in realistic (in vitro) falling conditions of the elderly. With the impact force of 6940 N used (a typical Hip impact force measured in in vitro falling tests), the trochanteric soft tissue (25 mm-thick polyethylene foam) attenuated the peak femoral impact force to 5590 N and the tested Protector to 1040 N. In the second series of this experiment, the peak femoral impact force was set to be so high (13,130 N) that the Protector, if effective, should prevent the Hip fracture in almost all cases. The trochanteric soft tissue attenuated this peak impact force to 10,400 N and the tested Protector to 1810 N. Thus, the force received by the proximal femur still remained clearly below 4170 N, the average force required to fracture in vitro the proximal femur of the elderly in a fall loading configuration. In conclusion, our test results suggest that an anatomically designed energy-shunting and energy-absorbing Hip Protector can provide an effective impact force attenuation in typical falling conditions of the elderly. However, the efficacy of the Protector in the prevention of Hip fractures can only be evaluated in randomized clinical trials. (J Bone Miner Res 1995 ;10 :1437-1442)

  • Hip Protectors: recommendations for biomechanical testing—an international consensus statement (part I)
    Osteoporosis International, 2009
    Co-Authors: S. Robinovitch, S. Birge, J. Minns, S. L. Evans, A. C. Laing, D. Plant, Siegfried Derler, Peter A Cripton, Pekka Kannus, I. D. Cameron
    Abstract:

    Introduction Hip Protectors represent a promising strategy for preventing fall-related Hip fractures. However, clinical trials have yielded conflicting results due, in part, to lack of agreement on techniques for measuring and optimizing the biomechanical performance of Hip Protectors as a prerequisite to clinical trials. Methods In November 2007, the International Hip Protector Research Group met in Copenhagen to address barriers to the clinical effectiveness of Hip Protectors. This paper represents an evidence-based consensus statement from the group on recommended methods for evaluating the biomechanical performance of Hip Protectors. Results and conclusions The primary outcome of testing should be the percent reduction (compared with the unpadded condition) in peak value of the axial compressive force applied to the femoral neck during a simulated fall on the greater trochanter. To provide reasonable results, the test system should accurately simulate the pelvic anatomy, and the impact velocity (3.4 m/s), pelvic stiffness (acceptable range: 39-55 kN/m), and effective mass of the body (acceptable range: 22-33 kg) during impact. Given the current lack of clear evidence regarding the clinical efficacy of specific Hip Protectors, the primary value of biomechanical testing at present is to compare the protective value of different products, as opposed to rejecting or accepting specific devices for market use.

  • Hip Protectors: recommendations for conducting clinical trials—an international consensus statement (part II)
    Osteoporosis International, 2009
    Co-Authors: I. D. Cameron, S. Robinovitch, S. Birge, J. Lauritzen, J. Howland, J. Minns, K Khan, S. Evans, Pekka Kannus, A. Laing
    Abstract:

    Introduction While Hip Protectors are effective in some clinical trials, many, including all in community settings, have been unable to demonstrate effectiveness. This is due partly to differences in the design and analysis. The aim of this report is to develop recommendations for subsequent clinical research. Methods In November of 2007, the International Hip Protector Research Group met to address barriers to the clinical effectiveness of Hip Protectors. This paper represents a consensus statement from the group on recommended methods for conducting future clinical trials of Hip Protectors. Results and conclusions Consensus recommendations include the following: the use of a Hip Protector that has undergone adequate biomechanical testing, the use of sham Hip Protectors, the conduct of clinical trials in populations with annual Hip fracture incidence of at least 3%, a run-in period with demonstration of adequate adherence, surveillance of falls and adherence, and the inclusion of economic analyses. Larger and more costly clinical trials are required to definitively investigate effectiveness of Hip Protectors.

  • Hip Protectors for preventing Hip fractures among elderly adults
    Aging Health, 2009
    Co-Authors: Jari Parkkari, Pekka Kannus
    Abstract:

    Prevention of fractures in the elderly consists of prevention and treatment of osteoporosis, prevention of falling and prevention of fractures using injury-site protection. Since the majority of Hip fractures in elderly people are caused by a sideways fall with direct impact on the greater trochanter of the proximal femur, one option to prevent the fracture is a biomechanically effective external Hip Protector. The biomechanical test results of an energy-shunting and energy-absorbing Hip Protector have demonstrated that this type of Hip Protector can provide an effective impact force attenuation in typical falling conditions of older adults by reducing the initial force down to the seventh part. Recent meta-analyses and systematic reviews combining findings of all different types of Hip Protectors suggest that in care homes and institutions with high rates of Hip fracture, the use of Hip Protectors might help to reduce the risk of fracture to 20–60%, but there is no evidence of a public health level benef...

I Vuori - One of the best experts on this subject based on the ideXlab platform.

  • energy shunting external Hip Protector attenuates the peak femoral impact force below the theoretical fracture threshold an in vitro biomechanical study under falling conditions of thel elderly
    Journal of Bone and Mineral Research, 2009
    Co-Authors: M Jari D Parkkari, Jussi Heikkila, J Poutala, Harri Sievanen, Pekka Kannus, I Vuori
    Abstract:

    The first objective of this study was to design a Hip Protector that would effectively attenuate and shunt away from the greater trochanter the impact energies created in typical falls of the elderly. As the shock absorption material, the Protector included the 12 mm-thick Plastazote, which was found to be the most efficient energy-absorbing material in our previous in vitro biomechanical tests. With an anatomically designed semiflexible outer shield of the Protector (high density polyethylene), the impact surface was increased and the impact energy shunted away from the greater trochanter. In the second phase of the study, we determined the force attenuation capacity of this device in realistic (in vitro) falling conditions of the elderly. With the impact force of 6940 N used (a typical Hip impact force measured in in vitro falling tests), the trochanteric soft tissue (25 mm-thick polyethylene foam) attenuated the peak femoral impact force to 5590 N and the tested Protector to 1040 N. In the second series of this experiment, the peak femoral impact force was set to be so high (13,130 N) that the Protector, if effective, should prevent the Hip fracture in almost all cases. The trochanteric soft tissue attenuated this peak impact force to 10,400 N and the tested Protector to 1810 N. Thus, the force received by the proximal femur still remained clearly below 4170 N, the average force required to fracture in vitro the proximal femur of the elderly in a fall loading configuration. In conclusion, our test results suggest that an anatomically designed energy-shunting and energy-absorbing Hip Protector can provide an effective impact force attenuation in typical falling conditions of the elderly. However, the efficacy of the Protector in the prevention of Hip fractures can only be evaluated in randomized clinical trials. (J Bone Miner Res 1995 ;10 :1437-1442)

  • energy shunting external Hip Protector attenuates the peak femoral impact force below the theoretical fracture threshold an in vitro biomechanical study under falling conditions of thel elderly
    Journal of Bone and Mineral Research, 2009
    Co-Authors: M Jari D Parkkari, Jussi Heikkila, J Poutala, Harri Sievanen, Pekka Kannus, I Vuori
    Abstract:

    The first objective of this study was to design a Hip Protector that would effectively attenuate and shunt away from the greater trochanter the impact energies created in typical falls of the elderly. As the shock absorption material, the Protector included the 12 mm-thick Plastazote, which was found to be the most efficient energy-absorbing material in our previous in vitro biomechanical tests. With an anatomically designed semiflexible outer shield of the Protector (high density polyethylene), the impact surface was increased and the impact energy shunted away from the greater trochanter. In the second phase of the study, we determined the force attenuation capacity of this device in realistic (in vitro) falling conditions of the elderly. With the impact force of 6940 N used (a typical Hip impact force measured in in vitro falling tests), the trochanteric soft tissue (25 mm-thick polyethylene foam) attenuated the peak femoral impact force to 5590 N and the tested Protector to 1040 N. In the second series of this experiment, the peak femoral impact force was set to be so high (13,130 N) that the Protector, if effective, should prevent the Hip fracture in almost all cases. The trochanteric soft tissue attenuated this peak impact force to 10,400 N and the tested Protector to 1810 N. Thus, the force received by the proximal femur still remained clearly below 4170 N, the average force required to fracture in vitro the proximal femur of the elderly in a fall loading configuration. In conclusion, our test results suggest that an anatomically designed energy-shunting and energy-absorbing Hip Protector can provide an effective impact force attenuation in typical falling conditions of the elderly. However, the efficacy of the Protector in the prevention of Hip fractures can only be evaluated in randomized clinical trials.

  • prevention of Hip fracture in elderly people with use of a Hip Protector
    The New England Journal of Medicine, 2000
    Co-Authors: Pekka Kannus, Mika Palvanen, Markku Järvinen, Seppo Niemi, Jari Parkkari, Markku Pasanen, I Vuori
    Abstract:

    Background Hip fractures are common in frail elderly adults worldwide. We investigated the effect of an anatomically designed external Hip Protector on the risk of these age-related fractures. Methods We randomly assigned 1801 ambulatory but frail elderly adults (1409 women and 392 men; mean age, 82 years), in a 1:2 ratio, either to a group that wore a Hip Protector or to a control group. Fractures of the Hip and all other fractures were recorded until the end of the first full month after 62 Hip fractures had occurred in the control group. The risk of fracture in the two groups was compared, and in the Hip-Protector group the risk of fracture was also analyzed according to whether the Protector had been in use at the time of a fall. Results During follow-up, 13 subjects in the Hip-Protector group had a Hip fracture, as compared with 67 subjects in the control group. The respective rates of Hip fracture were 21.3 and 46.0 per 1000 person-years (relative hazard in the Hip-Protector group, 0.4; 95 percent c...

  • Impact experiments of an external Hip Protector in young volunteers.
    Calcified Tissue International, 1997
    Co-Authors: Jari Parkkari, Jussi Heikkila, J Poutala, Harri Sievanen, Pekka Kannus, Ari Heinonen, I Vuori
    Abstract:

    This study represents the first measures and experiences of using an external Hip Protector in humans under forces that could, without the Protector, fracture the proximal femur of some of the elderly persons. In other words, we wanted to know if it is possible, using the Hip Protector, to hit the proximal femur of young volunteers with forces that have the power to fracture some individuals' proximal femur, and if so, how intense is the pain reaction under the impacted area? Four of the researchers (JP, AH, HS, and PK) volunteered to be the study subjects. In the impact experiments, we wore the Protector on both sides of the pelvis (greater trochanter), and the pendulum, with an effective mass of 40 kg, was impacted on the Protector. The descent height was gradually increased and the highest impact energy used was 115 J. With a load cell mounted on the head of the pendulum we ensured that the external forces used were high enough to fracture the proximal femur of some of the elderly people. Using the external Hip Protector we tolerated the impacts well although after the high energy impacts every subject reported mild tenderness on the skin area under the contact surface of the Protector. Repeated examinations of the impacted area of the study subjects did not reveal hematoma or swelling. In conclusion, our test results suggested that, when wearing an anatomically designed energy-shunting and energy-absorbing Hip Protector, the fall-induced peak impact forces do not cause undue pain to the impacted Hip region, and, in all probability, the forces entering into the proximal femur remain below the range of force capable of fracturing the proximal femur of the elderly. The Protector was found to be comfortable to wear and it did not move (slip away) during the experiment. We feel that our Protector is now ready for a feasibility study and then for a randomized clinical trial.

M Jari D Parkkari - One of the best experts on this subject based on the ideXlab platform.

  • energy shunting external Hip Protector attenuates the peak femoral impact force below the theoretical fracture threshold an in vitro biomechanical study under falling conditions of thel elderly
    Journal of Bone and Mineral Research, 2009
    Co-Authors: M Jari D Parkkari, Jussi Heikkila, J Poutala, Harri Sievanen, Pekka Kannus, I Vuori
    Abstract:

    The first objective of this study was to design a Hip Protector that would effectively attenuate and shunt away from the greater trochanter the impact energies created in typical falls of the elderly. As the shock absorption material, the Protector included the 12 mm-thick Plastazote, which was found to be the most efficient energy-absorbing material in our previous in vitro biomechanical tests. With an anatomically designed semiflexible outer shield of the Protector (high density polyethylene), the impact surface was increased and the impact energy shunted away from the greater trochanter. In the second phase of the study, we determined the force attenuation capacity of this device in realistic (in vitro) falling conditions of the elderly. With the impact force of 6940 N used (a typical Hip impact force measured in in vitro falling tests), the trochanteric soft tissue (25 mm-thick polyethylene foam) attenuated the peak femoral impact force to 5590 N and the tested Protector to 1040 N. In the second series of this experiment, the peak femoral impact force was set to be so high (13,130 N) that the Protector, if effective, should prevent the Hip fracture in almost all cases. The trochanteric soft tissue attenuated this peak impact force to 10,400 N and the tested Protector to 1810 N. Thus, the force received by the proximal femur still remained clearly below 4170 N, the average force required to fracture in vitro the proximal femur of the elderly in a fall loading configuration. In conclusion, our test results suggest that an anatomically designed energy-shunting and energy-absorbing Hip Protector can provide an effective impact force attenuation in typical falling conditions of the elderly. However, the efficacy of the Protector in the prevention of Hip fractures can only be evaluated in randomized clinical trials. (J Bone Miner Res 1995 ;10 :1437-1442)

  • energy shunting external Hip Protector attenuates the peak femoral impact force below the theoretical fracture threshold an in vitro biomechanical study under falling conditions of thel elderly
    Journal of Bone and Mineral Research, 2009
    Co-Authors: M Jari D Parkkari, Jussi Heikkila, J Poutala, Harri Sievanen, Pekka Kannus, I Vuori
    Abstract:

    The first objective of this study was to design a Hip Protector that would effectively attenuate and shunt away from the greater trochanter the impact energies created in typical falls of the elderly. As the shock absorption material, the Protector included the 12 mm-thick Plastazote, which was found to be the most efficient energy-absorbing material in our previous in vitro biomechanical tests. With an anatomically designed semiflexible outer shield of the Protector (high density polyethylene), the impact surface was increased and the impact energy shunted away from the greater trochanter. In the second phase of the study, we determined the force attenuation capacity of this device in realistic (in vitro) falling conditions of the elderly. With the impact force of 6940 N used (a typical Hip impact force measured in in vitro falling tests), the trochanteric soft tissue (25 mm-thick polyethylene foam) attenuated the peak femoral impact force to 5590 N and the tested Protector to 1040 N. In the second series of this experiment, the peak femoral impact force was set to be so high (13,130 N) that the Protector, if effective, should prevent the Hip fracture in almost all cases. The trochanteric soft tissue attenuated this peak impact force to 10,400 N and the tested Protector to 1810 N. Thus, the force received by the proximal femur still remained clearly below 4170 N, the average force required to fracture in vitro the proximal femur of the elderly in a fall loading configuration. In conclusion, our test results suggest that an anatomically designed energy-shunting and energy-absorbing Hip Protector can provide an effective impact force attenuation in typical falling conditions of the elderly. However, the efficacy of the Protector in the prevention of Hip fractures can only be evaluated in randomized clinical trials.

I. D. Cameron - One of the best experts on this subject based on the ideXlab platform.

  • Hip Protectors: recommendations for biomechanical testing—an international consensus statement (part I)
    Osteoporosis International, 2009
    Co-Authors: S. Robinovitch, S. Birge, J. Minns, S. L. Evans, A. C. Laing, D. Plant, Siegfried Derler, Peter A Cripton, Pekka Kannus, I. D. Cameron
    Abstract:

    Introduction Hip Protectors represent a promising strategy for preventing fall-related Hip fractures. However, clinical trials have yielded conflicting results due, in part, to lack of agreement on techniques for measuring and optimizing the biomechanical performance of Hip Protectors as a prerequisite to clinical trials. Methods In November 2007, the International Hip Protector Research Group met in Copenhagen to address barriers to the clinical effectiveness of Hip Protectors. This paper represents an evidence-based consensus statement from the group on recommended methods for evaluating the biomechanical performance of Hip Protectors. Results and conclusions The primary outcome of testing should be the percent reduction (compared with the unpadded condition) in peak value of the axial compressive force applied to the femoral neck during a simulated fall on the greater trochanter. To provide reasonable results, the test system should accurately simulate the pelvic anatomy, and the impact velocity (3.4 m/s), pelvic stiffness (acceptable range: 39-55 kN/m), and effective mass of the body (acceptable range: 22-33 kg) during impact. Given the current lack of clear evidence regarding the clinical efficacy of specific Hip Protectors, the primary value of biomechanical testing at present is to compare the protective value of different products, as opposed to rejecting or accepting specific devices for market use.

  • Hip Protectors: recommendations for conducting clinical trials—an international consensus statement (part II)
    Osteoporosis International, 2009
    Co-Authors: I. D. Cameron, S. Robinovitch, S. Birge, J. Lauritzen, J. Howland, J. Minns, K Khan, S. Evans, Pekka Kannus, A. Laing
    Abstract:

    Introduction While Hip Protectors are effective in some clinical trials, many, including all in community settings, have been unable to demonstrate effectiveness. This is due partly to differences in the design and analysis. The aim of this report is to develop recommendations for subsequent clinical research. Methods In November of 2007, the International Hip Protector Research Group met to address barriers to the clinical effectiveness of Hip Protectors. This paper represents a consensus statement from the group on recommended methods for conducting future clinical trials of Hip Protectors. Results and conclusions Consensus recommendations include the following: the use of a Hip Protector that has undergone adequate biomechanical testing, the use of sham Hip Protectors, the conduct of clinical trials in populations with annual Hip fracture incidence of at least 3%, a run-in period with demonstration of adequate adherence, surveillance of falls and adherence, and the inclusion of economic analyses. Larger and more costly clinical trials are required to definitively investigate effectiveness of Hip Protectors.

Mohamad Ikhwan Zaini Ridzwan - One of the best experts on this subject based on the ideXlab platform.

  • Test systems for the biomechanical evaluation of Hip Protectors: a systematic review
    Osteoporosis International, 2019
    Co-Authors: S. A. Yahaya, Zaidi Mohd Ripin, Mohamad Ikhwan Zaini Ridzwan
    Abstract:

    Various mechanical and biomechanical test systems to evaluate the effectiveness of Hip Protectors designed to prevent Hip fracture as a result of falls were examined in this review. The articles considered were selected systematically. The effect of differences in design criteria was demonstrated, and it was observed that the impact energy employed during testing dramatically affects the performance of the Hip Protector. Over the past three decades, researchers have continuously experimented with various systems to determine the efficacy of various Hip Protectors. The primary aim has been to make informed decisions in optimizing Hip Protector design. This article provides a systematic review of various test systems employed in the determination of the biomechanical efficacy of Hip Protectors. A systematic literature search was carried out, and 28 relevant articles were included to demonstrate the effect of test systems in the evaluation of the biomechanical effectiveness of Hip Protectors. Methodological studies illustrated the appropriate use of impact testing systems for the simulation of Hip anatomy and fall dynamics in evaluating the effectiveness of Hip Protectors in preventing a Hip fracture. This systematic review has demonstrated the effect of the variability of test systems on the evaluation of impact attenuation by various Hip Protectors. The lack of standardized test systems accounts for the inconsistencies in the test results of the efficacy of Hip Protectors. This has been a major challenge in the efforts of researchers to optimize the interventions. The standardization of test systems may require needed improvements immediately as opposed to the development of new interventions in order to ensure that only Hip Protectors with adequately proven efficacies are deployed for clinical trials or for the protection of the Hips of vulnerable individuals from sideways impact.