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Every year around 70,000 people in the UK break their hip. Hip fractures can take a long time to recover from and can lead to a range of complications associated with their reduced mobility, including pressure ulcers. Pressure ulcers (PU) are caused by sitting/lying in one position or being unable to move a part of the body. They cause pain, discomfort, and distress to patients, leading to reduced quality of life and sometimes death. They range in seriousness: Category 1 is a reddened area; Category 2 is a blister/skin loss and Categories 3 and 4 are deep wounds.

People with a hip fracture are at high risk of heel PU development due to difficulty moving their affected leg and use of the opposite heel when pushing themselves up/moving in bed. Factors which lead to hip fractures are also risks for PU development, for example frailty. If PUs develop on the heel of a person with a hip fracture, they cause added problems as they take a long time to heal (often months) reducing mobility, affecting the shoes they can wear and increasing their time to start walking again. This project is about the prevention of heel PUs in patients with hip fractures. Usual care for PU prevention includes specialist mattresses, electric powered bedframes and repositioning in bed.

PRESSURE 3 will compare the cost-effectiveness of usual care alone with usual care plus one of two types of specialist heel equipment:
a) heel off-loading devices ensuring no contact with the heel. They include foam troughs and boots which are applied to the legs
b) Constant low pressure (CLP) devices which are softer than a mattress and so reduce the pressure at the heel. They include pads made of foam or gel and are laid on top of the bedsheet.