Trauma
KADOORIE CENTRE
FOR CRITICAL CARE
RESEARCH AND
Research & Development
EDUCATION
V O L U M E
OUR RESEARCH
THEMES
 Effectiveness of
treatments
 Rehabilitation
 Patient / Staff
experience
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F E B R U A R Y
Optimising Mobility after Severe Ankle Injury
David Keene has recently
been awarded a DPhil from
the University of Oxford for
his research into the recovery
of mobility after severe ankle
sprains and fractures. This
thesis studied a key dilemma
in early rehabilitation,
whether to immobilise the
ankle or allow joint motion.
immobilisation versus early
ankle movement after internal
fixation surgery for ankle
fracture. To investigate the
role of different types of ankle
supports in rehabilitation of
walking after internal fixation
surgery, two randomised cross
-over studies were completed
using detailed gait analysis.
The research included a
systematic review of
randomised controlled trials.
The review pooled the results
of trials investigating ankle
Finally, a secondary analysis of
a cohort of patients with
severe ankle sprain was
conducted. Publications
Optimising
mobility after
severe ankle
injury
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DRAFFT Results
DRAFFT Results
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PATH 2
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Isobel Menzies
Lyth
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SPRAINED
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The Distal Radius Fracture
Fixation Trial was a large multicentre randomised study run by
Professor Matt Costa,
Orthopaedic Consultant and
Professor of Trauma and
Orthopaedic Surgery at Warwick
University. Oxford was one of the
sites that recruited to this study.
The study compared two
common methods of treating
dorsally displaced distal radius
fractures in adults within the UK.
These were Locking-plate fixation
and Kirschner (K)-wire fixation
(pictured).
Celebrating
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Trauma Research
Capture the
Fracture
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Forthcoming
Meetings
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Contact Details
4
Selected
References
4
2 0 1 5
Contact: David Keene
across 18 sites with over 90% follow
up completed at one year.
The results show that wrist function
improved in both groups by 12
months and that there was no
clinically significant difference in
PRWE at 3, 6 or 12 months.
Locking Plate
The primary outcome measure
for the study was function which
was assessed one year post-injury
using the Patient Rated Wrist
Evaluation Score (PRWE).
461 participants were recruited
detailing the findings from the
DPhil are now in progress.
Secondary outcome measures
(disabilities of the arm, shoulder and
hand (DASH), EuroQol (EQ5D), and
surgical complications) also showed
no clinically significant difference.
Thus the trial has showed no
difference in functional outcome
between the two treatment methods.
Of note Kirschner wire fixation is
cheaper and quicker to perform.
Results available on
BMJ Open Access.
Kirschner Wire
Contact: Louise
Spoors
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Platelet Rich Plasma in Achilles
Tendon Healing
We are delighted to announce
funding for this study from the
MRC-NIHR partnership:
EME Programme. The study is
currently in the final stages of
development and we hope to
start in Oxford in April. It is a
multi-centre, randomised trial
comparing Platelet Rich Plasma
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ISSUE
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injection (PRP) and placebo
(imitation) injection in adults
with Achilles tendon rupture.
Two sub-studies are embedded
within the main study to
contribute to the understanding
of the PRP mechanism in tendon
healing. The Pilot study was
carried out by Joe Alsousou as
part of his DPhil.
Contact: Susanna Symonds
Joseph Alsousou
Isobel Menzies Lyth
health and nursing, the private
sector, social welfare and education.
The chapter reflects on Isabel
Menzies Lyth’s (1960) study of the
way nursing was enacted at that
time and examines some of the
developments in nursing in light of
current concerns.
Debbie Langstaff and Liz Tutton
(pictured above) have contributed a
chapter to David Armstrong and
Michael Rustin’s book on Social
Defences against anxiety,
explorations in a paradigm
published by Karnac books. The
book provides a theoretical and
practical exploration of social
defences in a range of settings:
Menzies Lyth identified the
routinised and ritualistic nature of
nursing work that mitigated against
developing relationships, failed to
use staff’s skills and abilities and
created a heighten sense of anxiety.
Much work has occurred in nursing
research and practice to develop
improved ways of working and
better care environments for
SPRAINED: Synthesising a
clinical Prognostic Rule for
Ankle INjuries in the Emergency
Department
The SPRAINED study officially
started on the 1st of November
2014. The study aims to develop
a prognostic tool to predict
recovery for ankle sprain patients
presenting to Emergency
people in need of health services.
Developments in practice have
occurred through a better
understanding of the craft of nursing,
finding ways of organizing nursing
that facilitate knowing the patient,
and exploring the way emotional
labour is enacted in practice. Current
health care, societal and managerial
changes require us to revisit the
fundamental ways in which nursing is
undertaken whilst being attuned to
our past. Re examining how we
experience and make sense of
anxiety within the current context
may be a fruitful way forward.
Contact : Liz Tutton
Departments (ED) and Minor
Injury Units (MIU).
Recruitment is planned to start in
May 2015.
The tool is currently being
developed using a variety of
methods including statistical
modelling, systematic literature
reviewing and a consensus group
meeting. The tool will then be
validated in a cohort study
involving 675 ED & MIU patients.
The study Chief Investigator is
Professor Sallie Lamb and study
lead is Dr Mark Williams.
Contact: Mark Williams
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Trauma Research in the Thames Valley
Celebrating Trauma
Research in the Thames
Valley
Trauma Network. There was a
great deal of discussion, networking
and plans made for the future.
A successful event was held at
Whiteknights Campus, University
of Reading to present and
discuss on going research in the
Thames Valley. The event was
organised by Andrew McAndrew,
Liza Keating, Katie KeatingFedders and the Reading team
and supported by Thames Valley
The Oxford team were present and
presentations were made by: Lynn
Hutchings, Prediction of multiple
organ failure following trauma; Mark
Williams, Conducting large - scale
randomised controlled trials in the
emergency department - examples
from the Centre for Rehabilitation
Research in Oxford and
Synthesising a clinical Prognostic
Rule for Ankle Injuries in the
Emergency department - the
SPRAINED study; David Keene,
Recruiting to target in a multicentre orthopaedic trauma study:
lessons learned from the Ankle
Injury Management (AIM) trial; Liz
Tutton, Open fracture of the lower
limb: patients’ experience whilst in
acute care. Lynn Hutchings won a
prize for the high quality of her
work.
Capture the Fracture
The Oxfordshire Fracture
Prevention Service has been given
a Gold Standard Award by the
International Osteoporosis
Foundation in the ‘capture the
fracture’ global campaign, for the
implementation of secondary
fracture prevention.
Osteoporosis is a disease in which
density and quality of bone are
reduced. As bones become more
porous and fragile, the risk of
fracture is greatly increased. The
loss of bone is silent and
progressive and often there are no
symptoms until the first fracture
occurs.
One in three women and one in
five men have osteoporosis.
Globally a fragility fracture occurs
every 3 seconds. This award has
been given in recognition of the
work undertaken by the team to
meet the 13 globally endorsed
standards for the care of
individuals with fragility fractures.
It provides a unique platform to
share the best practices developed
within the Fracture Prevention
Service with colleagues
worldwide, and make a significant
and valuable contribution to
improving the care of individuals
experiencing fragility fractures.
www.capture-the-fracture.org
Contact: Kerri Rance
kerri.rance@ouh.nhs.uk
Lin Lyzba, Kerri Rance, Rachel Knight,
Carol Weeks and Dr Kassim Javaid
Forthcoming Meetings
Injuries and Emergencies
Speciality Group (IESG) is
part of the Thames Valley and
South Midlands Clinical Research
Network (TVCRN).
Chairman: Mr Andrew
MacAndrew.
Next meetings:
1.30pm on Friday 13th March
2015, Royal Berkshire
Hospital and Friday 3rd July
2015, TRL, Crowthorne.
Lunch will be served from
12.30pm
Trauma Orthopaedic
Research Collaboration
(TORC): This is a national
meeting attended by a mixture of
Trauma, Ortho-geriatric and Bone
& Metabolic Health specialists and
multidisciplinary staff.
Chairman: Tim Chesser
Next Meetings:
Next meeting Friday 15th May
Kadoorie Centre, Oxford
Meeting starts at 11am - 2 pm
(Lunch will be provided)
Research Café: This is a new
meeting organised by Sally Beer
for local research staff to drop in,
meet fellow research staff, share
good and bad experiences and
learn from each other.
Next Meetings:
Wednesday 11th March at
3.30 - 5pm at Tingewick
Foyer, John Radcliffe Hospital
Contact: Louise Spoors/
Susanna Symonds
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Kadoorie Centre
for Critical Care Research and Education
Email addresses
josephalsousou@doctors.org.uk
Level 3
John Radcliffe Hospital
chris.bouse@ouh.nhs.uk
lynn.hutchings@ndorms.ox.ac.uk
Oxford
david.keene@ndorms.ox.ac.uk
OX3 9DU
sarah.lamb@ndorms.ox.ac.uk
sally.lambert@ouh.nhs.uk
debbie.langstaff@ouh.nhs.uk
Contact: Chris Bouse
lesley.morgan@ndorms.ox.ac.uk
Phone:
01865 223101
emma.roberts@ndorms.ox.ac.uk
01865 223103
louise.spoors@ouh.nhs.uk
Fax:
www.ouh.nhs.uk/kadoorie/
01865 223102
susanna.symonds@ouh.nhs.uk
liz.tutton@ouh.nhs.uk
keith.willett@ndorms.ox.ac.uk
mark.williams@ndorms.ox.ac.uk
julie.wright@ouh.nhs.uk
Selected Recent References
Costa ML, Achten J, Parsons
NR, Rangan A, Griffin D,
Tubeuf S, Lamb SE. (2014)
Percutaneous fixation with
Kirschner wires versus volar locking
plate fixation in adults with dorsally
displaced fracture of distal radius:
randomized controlled trial. BMJ
349:g4807 http://www.bmj.com/
content/349/bmj.g4807
Perkins GD, Lall R, Quinn T,
Deakin CD, Cooke MW,
Horton J, Lamb SE, Slowther
AM, Woollard M, Carson A,
Smyth M, Whitfield R,
Williams A, Pocock H, Black JJ,
Wright J, Han K, Gates S;
PARAMEDIC trial collaborators
(2014)
Mechanical versus manual chest
compression for out-of-hospital cardiac
arrest (PARAMEDIC): a pragmatic
cluster randomized controlled trial.
Lancet Nov 16. pii: S0140-6736(14)
61886-9. doi: 10.1016/S0140-6736(14)
61886-9
Prestmo A, Hagen G, Helbostad
O, Thingstad P, Taraldsen K,
Lydersen S, Halsteinli V, Saltnes,
Lamb SE, Johnsen L, Saltvedt I.
(2015)
Comprehensive geriatric care for
patients with hip fractures: a
prospective, randomized, controlled
trial. Feb 5; http://dx.doi.org/10.1016/
S0140-6736(14)62409-0
Cole E, Davenport R, Willett K,
Brohi K. (2015)
Tranexamic acid use in severely injured
civilian patients and the effects on
outcomes: a prospective cohort study.
Ann Surg. Feb;261(2):390-4. doi:
10.1097/SLA. 0000000000000717
Useful Links
Clinical Research Network: www.crn.nihr.ac.uk/
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences:
www.ndorms.ox.ac.uk
Injury Minimization Programme for Schools (I.M.P.S.): www.impsweb.co.uk
University of Oxford: www.ox.ac.uk
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