Orthopaedic Trauma Hospital Outcomes – Patient Operative Delays: A prospective multicentre service evaluation of trauma burden and resources.

The Orthopod Project has now finished collecting data, having recorded over 24,000 patient episodes across over 85 hospitals nationwide.  Led by Mr Will Eardley and Tom Baldock, there are four papers being written from this data.  It is a prime example of collaborative research at its best, and we look forward to the results.  Thank you to everyone who has contributed to Orthopod!  Data is being analysed and the first paper was published in March 2023 in Injury.

Wei N, Baldock TE, Elamin-Ahmed H, Walshaw T, Walker R, Trompeter A, Eardley WPG; ORTHOPOD Collaborators. ORthopaedic trauma hospital outcomes - Patient operative delays (ORTHOPOD) Study: The management of day-case orthopaedic trauma in the United Kingdom. 

Injury. 2023 Mar 24:S0020-1383(23)00288-7. doi: 10.1016/j.injury.2023.03.032. Epub ahead of print. PMID: 37005137.

A Prospective Multicentre Service Evaluation of Fractures Around the Knee in Older Patients

The KNEE study is a multicentre prospective service evaluation that intends to examine the epidemiology, treatment decision making, operative techniques utilised and peri-operative optimisation of older patients presenting with fractures around the knee.

Project objectives

• Define the current epidemiology of fractures around the knee in older patients in the United Kingdom (UK). 

• Describe the treatment decision making surrounding operative vs non-operative care. 

• Describe the current operative techniques utilised when operative management is selected. 

• Describe the systems in place for the peri-operative optimisation of this patient cohort. 

• Describe the current process of post-operative care in this patient cohort.

KNEE has now finished with data collection and we look forward to seeing what it has found.

COMPOSE was a national multi centre, retrospective service evaluation examining the characteristics, outcomes and management of peri-prosthetic fractures presenting to secondary care in the UK. 

Two papers were also published from the results of this.

A B Scrimshire, A Farrier, L Kottam, R Walker, S Jameson, P Baker, O8 The COMPOSE Study: Characteristics, Outcomes and Management of PeriprOsthetic fractures: a Service Evaluation, BJS Open, Volume 5, Issue Supplement_1, April 2021, zrab033.007,  https://academic.oup.com/bjsopen/article/5/Supplement_1/zrab033.007/6217252?login=false 

Management and outcomes of femoral periprosthetic fractures at the hip

The COMPOSE Study Team

The Bone & Joint Journal 2022 104-B:8, 997-1008 

https://boneandjoint.org.uk/article/10.1302/0301-620X.104B8.BJJ-2021-1682.R1  

Another excellent example of national collaboration.  This study's aims were 

• To describe the incidence of different types of open fractures and how these injuries are managed within different units.

• To describe the patient characteristics of the cohort of patient who sustain an open fracture.

• To obtain basic information about the clinical outcomes following open fractures with regards to length of stay, complications and transfer to specialist units.

Two papers have now been published on the back of the OPEN study.

The Open-Fracture Patient Evaluation Nationwide (OPEN) study

James N. Hadfield, Tomisin S. Omogbehin, Charlotte Brookes, Reece Walker, Alex Trompeter, Christopher P. Bretherton, Andrew Gray, William G. P. Eardley, and on behalf of the Open Fracture Patient Evaluation Nationwide (OPEN) collaborators

Bone & Joint Open 2022 3:10, 746-752 

The Open-Fracture Patient Evaluation Nationwide (OPEN) study

Robert J. H. Winstanley, James N. Hadfield, Reece Walker, Christopher P. Bretherton, Neil Ashwood, Keith Allison, Alex Trompeter, William G. P. Eardley, and on behalf of the Open-Fracture Patient Evaluation Nationwide (OPEN) collaborators

The Bone & Joint Journal 2022 104-B:9, 1073-1080 

UKFROST is the largest clinical trial of its kind about treating a frozen shoulder in secondary care. It was funded by the NIHR Health Technology Assessment programme (13/26/01) and led by Professor Amar Rangan at South Tees Hospitals NHS Foundation Trust and University of York Trials Unit. A common key hole surgery, Arthroscopic Capsular Release, and a minimally invasive procedure, Manipulation under Anaesthesia, were compared with each other and also compared with a bespoke programme of physiotherapy with a steroid injection. Our research found that expensive key hole surgery was not better on patient-reported outcomes than the two alternative therapies. The bespoke physiotherapy with a steroid injection could be accessed quickly, had relatively fewer risks than key hole surgery and was cheaper, but more patients required further treatment. Overall MUA was found to be the most cost-effective option that provided the NHS with the best value for money spent in terms of health gains for the patient. This animation could be used to facilitate shared decision-making between the patient and clinician. https://doi.org/10.1016/S0140-6736(20)31965-6

SWIFFT is the largest clinical trial of its kind about treating a fracture of the waist of the scaphoid. It was funded by the NIHR Health Technology Assessment programme (11/36/37) and led by Professor Joseph Dias at University of Hospitals Leicester NHS Foundation Trust in collaboration with University of York Trials Unit. The authors concluded that adult patients with scaphoid waist fractures displaced by 2 mm or less should have initial cast immobilisation, and any suspected non-unions should be confirmed and immediately fixed with surgery. This treatment strategy will help to avoid the risks of surgery and mostly limit the use of surgery to fixing fractures that fail to unite. The findings are published in The Lancet (DOI:https://doi.org/10.1016/S014-06736(20)30931-4) and an infographic summarising the study results are available here. This infographic could be used to facilitate shared decision-making with patients.

A randomized controlled trial comparing the Thompson hemiarthroplasty with the Exeter polished tapered stem and Unitrax modular head in the treatment of displaced intracapsular fractures of the hip

Findings: A cemented Thompson hemiarthroplasty may provide similar health-related quality of life compared with modern implants for patients with a displaced intracapsular fracture of the hip. Published Online:8 Mar 2018https://doi.org/10.1302/0301-620X.100B3.BJJ-2017-0872.R2

Fracture Assessment, Management and Outcomes in Upper Limb Study during C-19

This was a UK-wide multi-centre observational cohort study led by Prof Rangan in the North East. It used remote follow up with patient questionnaires to investigate the impact of COVID-19 pandemic on distal radial and proximal humeral fracture management within the UK, and to quantify any impact on patient outcomes.  Data collection is now complete and analysis underway.

See here for more information.

• Acromio-Clavicular Joint Dislocation Cohort Study

• An observational cohort study to evaluate frequency, management and outcomes of severe ACJ Injuries (Grade III and above)

• Study results were published in Shoulder and Elbow

• A prospective multi-centre observational cohort study to evaluate frequency, management and outcomes of acute severe (grade III–VI) acromioclavicular joint injuries in the United Kingdom. Shoulder & Elbow. 2022;0(0). doi:10.1177/17585732221088553

• Nationwide RCT comparing PROMS for compression bandaging v wool and crepe post-TKR.

• Recruitment complete now collecting follow up data.

• STeroid INjections durinG C19

• This prospective service evaluation aims to quantify risk associated with any musculo-skeletal steroid injection during the pandemic. Ran by the national plastics and hands research collaborative, the Reconstructive Surgery Trials Network.