Dear Sir,
We would like to draw to your attention the great strides that have been made in the UK with regard to national multicentre clinical trials in musculoskeletal trauma. Taking our lead from the Canadian Orthopaedic Trauma Society (COTS) and supported by the UK government through National Institute for Health Research (NIHR) funding, a number of multientre randomised controlled trials evaluating trauma interventions are now running in the NHS. The trial groups met for a Research Collaborators’ Meeting in London on the 27th September 2012. For those who could not attend the day, we would like to share some of the important points.
A total of 85 researchers from all disciplines – surgeons, nurses, physiotherapists and researchers – attended with much enthusiasm. The day started with updates on the four trials which are currently open. AIM (Ankle Injury Management) is currently recruiting across 20 centres throughout the UK and is comfortably on target to reach its recruitment deadline. The study evaluates surgery versus close contact casting for ankle fractures in older patients. DRAFFT (Distal Radius Acute Fracture Fixation Trial) compares locking-plate fixation with wire fixation and has recruited beyond its original sample size target. ProFER compares operative and nonoperative treatment for patients with a fracture of the proximal humerus; this trial is also in the follow-up stage, having successfully completed recruitment. Finally, WOLLF (Wound management of Open Lower Limb Fractures) is open in five sites and will roll out across the country in early 2013.
The trial updates and the surrounding discussion highlighted the importance of pragmatic study design and the enthusiasm and commitment in all the centres taking part, for success of the studies. There were two excellent guest speakers. Professor Sallie Lamb gave a fantastic talk on behalf of the Health Technologies Assessment programme on making successful grant applications, and the day was rounded off by Professor Jagdeep Nancharal, who spoke about the potential for accelerating fracture healing through up-regulation of cytokines. In addition to these, small focus group sessions on the AIM study and WOLLF study were supplemented with practical sessions.
We encourage investigators at other units to enrol their centres in ongoing studies and draw the attention of current investigators to a subsequent NIHR clinical trials day on March 8th 2013 which will be taking place in Birmingham, UK. Further details are available via the Warwick Clinical Trials unit.
Matthew Costa, PhD, FRCS(Tr & Orth), Professor of Trauma and Orthopaedic Surgery, Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
Written on Behalf of the NIHR Musculoskeletal Trauma Trials Collaboration
Editor-in-Chief’s comment
The UK has an almost unique system for allowing nationally co-ordinated research projects which has, up to this point, not been harnessed for large orthopaedic trials. It is great to see this government-funded infrastructure starting to be used for the benefit of our patients. It is heartening to see a real shift in the quality of evidence starting to inform our practice in all areas of orthopaedics from all areas of the globe. As a surgical subspecialty, orthopaedics is beginning to see the best ‘evidence-based’ surgical interventions; something we wholly believe in at 360, and we congratulate the investigating teams.
