Trauma
KADOORIE CENTRE
FOR CRITICAL CARE
RESEARCH AND
Research & Development
EDUCATION
V O L U M E
OUR RESEARCH
THEMES
6 ,
I S S U E
treatments
 Rehabilitation
 Patient / Staff
experience
INSIDE
THIS
ISSUE:
WHiTE study
1
Congratulations
1
FAB update
2
WOLLF update
2
SWIFFT update
2
Research Poster
3
Orthopaedic and
Trauma Nursing
3
Forthcoming
Meetings
3
Contact Details
4
Selected
References
4
S E P T E M B E R
2 0 1 4
WHiTE study
The Warwick Hip Trauma
Evaluation Study
 Effectiveness of
2
Hip fractures are one of the
greatest challenges facing the
medical community. They
constitute a heavy
socioeconomic burden
worldwide. Acute NHS Trusts
are required to follow-up and
record data about all patients
admitted with a hip fracture as
part of the National Hip
Fracture Audit. Currently, this
audit provides a framework
for service evaluation. This
evaluation is based upon the
assessment of process rather
than assessment of patientcentred outcome and
therefore it fails to provide
meaningful data regarding the
clinical effectiveness of
treatments.
The WHiTE study aims to
capture data from a cohort of
patients who present with a
hip fracture at 12 hospitals
within the United Kingdom.
We will record important
patient-centred outcomes in
patients and may then test the
clinical effectiveness of
experimental interventions
through embedded randomised
controlled trials.
fracture who are treated on the
same standardised hip
fracture pathway
Exclusion Criteria: Patients
younger than 60 years of age
or who are managed nonoperatively.
This study is jointly sponsored
by the University of Warwick
and University Hospitals
Coventry and Warwickshire
NHS Trust and the Chief
Investigator is Professor
Matthew Costa from Warwick
Clinical Trials Unit.
Inclusion Criteria: All
patients presenting with a hip
Contact: Louise Spoors
Oxford has been chosen to be
one of the 12 sites to run this
trial. We anticipate to start
recruitment in September 2014.
Congratulations
We are delighted to announce
that Miss Lynn Hutchings and
Mr Joseph Alsousou have both
been awarded a DPhil from
the University of Oxford.
Lynn Hutchings’ study has
focussed on predicting multiple
organ failure after major
trauma. Using existing
databases Lynn has identified
risk factors that lead to
multiple organ failure. These
factors can be identified within
2 hours of trauma injury. This
study will be used to develop a
clinical risk score to facilitate
improvements in care.
platelet rich plasma, a blood
product derived from the
patient’s own blood. The
findings provide a good
grounding for further work in
this area. Publications from both
studies are in progress.
Lynn Hutchings
Joseph Alsousou’s study has
explored the role of plateletrich plasma in Achilles tendon
healing. A range of
investigations took place
including a pilot randomised
controlled trial. Participants in
the treatment arm received
Joseph Alsousou
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FAB update
FAB (Fractures and
Bisphosphonates) is a doubleblind, randomised controlled
trial looking at the effect of
Alendronic Acid on healing and
clinical outcomes of wrist
fractures. Any patient over the
age of 50 with a distal radius
fracture may therefore be
eligible to enter the study.
Follow up is a big commitment
as participants are required to
attend clinic every 2 weeks for
the first 8 weeks. Recruitment
therefore can be a challenge,
especially in Oxford as we are a
big county and patients may
have to travel quite a distance.
However, we have recruited 22
patients and have earned our
4th Bronze award for
recruitment.
FAB has done very well with 324
patients enrolled on the study
across the 15 sites open in the UK.
There are 8 months left of
recruitment and because the drop
out rate has been less than
anticipated, only another 126 or so
participants are required.
Contact: Louise Spoors
WOLLF update
The WOLLF trial is a randomised
control trial of standard wound
management versus negative
pressure (vacuum) wound therapy
for the treatment of adult patients
with an open fracture of the lower
limb. If the surgeon is unable to
close the wound at their first
operation then the patient may be
eligible to enter the trial. Oxford
was initially a feasibility site when
the study opened late 2012. There
are now a total of 23 sites open to
the main phase trial nationally.
WOLLF have met the 50% target
predicted for this summer. At
Oxford and overall they are on
schedule to meet the 460 anticipated
participant recruitment target which
ends in September 2015.
Contact: Louise Spoors
SWIFFT update
SWIFFT is a multi-centre randomised controlled trial evaluating cast
treatment versus surgical fixation on wrist function for fractures of
the scaphoid waist in adults.
The study opened in Oxford in February 2014, and we were fully up
and running by April 2014 following some technical issues.
We have recruited 11 participants so far and are one of their best
recruiters. Recruitment overall for the study has rapidly improved in
recent months. This is because an outstanding 28 sites are now fully
open. Thus SWIFFT is at 97% of their target rate.
The study is open to participants over the age of 16 who meet
eligibility criteria. However, it has sometimes been difficult to keep
the younger generation of this age group engaged in the study.
Despite early study appointments taking place at the same routine
clinical follow up appointment, some participants have failed to
attend clinic altogether.
SWIFFT are holding an away day in October at Leicester for
research staff involved with the study to share their practice and
experiences relating to recruitment and retention of patients in the
study and various other aspects of the study.
Contact: Louise Spoors
Scaphoid waist fracture depicted by
arrow
Surgical fixation of scaphoid waist
fracture
VOLUME
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Research Poster
David Keene is a research
physiotherapist based at the
Kadoorie Centre for Critical
Care Education and Research. He
is currently reading for a DPhil in
Musculoskeletal Science at the
University of Oxford.
He recently won an award for
best research poster at the 5th
NIHR Doctoral Training Camp.
This award was presented by
Prof Dame Sally Davies (pictured
opposite).
Research Poster Title: Early
ankle movement versus
immobilisation in the postoperative management of
ankle fracture in adults:
a systematic review and metaanalysis.
Authors: David J. Keene, Dr Esther
Williamson, Dr Julie Bruce, Prof Keith
Willett, Prof Sarah (Sallie) E. Lamb
Contact: David Keene
Orthopedic and Trauma Nursing
Riding the waves: current
trends in orthopaedic and
trauma care. RCN Society of
Orthopaedic and Trauma
Nursing International
Conference and Exhibition
2014.
Liz Tutton (RCNRI, Trauma
Research, Oxford), Susanna
Symonds (Research Nurse,
Trauma Research, Oxford) and
Julie Wright (Nurse Consultant,
Trauma Unit, Oxford) all gave
papers at the conference that was
held in Brighton. Grainne Murphy
(Trauma Unit) also attended. Liz
Tutton provided evidence to
support the importance of patient
experience within the context of
developing practice. She drew on
current studies of patient
experience of traumatic injury and
placed it within the context of
emotional labour. Susanna
Symonds presented a paper on
the challenges of maintaining a
research culture in trauma. She
identified the historical
development of research in
trauma and raised challenges in
relation to recruitment, funding
and creating a sustainable research
culture. Julie Wright explored the
role of the nurse consultant:
assessing the impact one year on.
She presented evidence of the
strengths and challenges within
the role and the benefits within
the evolution of Major Trauma
Networks.
Contact: Liz Tutton
Susanna Symonds, Julie Wright,
Grainne Murphy
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 26th
September at Stoke
Mandeville and Friday 5th
December at Wexham Park.
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:
Friday 3rd October in Oxford,
16th January in Bristol, 15th
May in Oxford.
Meeting starts at 11am - 2 pm for
a light lunch.
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:
Thursday 2nd October and
Wednesday 5th November at
3.30 - 5pm at the George
Pickering Education Centre,
John Radcliffe Hospital
Contact: Louise Spoors/Susanna
Symonds
3
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VOLUME
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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
Oxford
lynn.hutchings@ndorms.ox.ac.uk
OX3 9DU
david.keene@ndorms.ox.ac.uk
sarah.lamb@ndorms.ox.ac.uk
sally.lambert@ouh.nhs.uk
debbie.langstaff@ouh.nhs.uk
Contact: Chris Bouse
Phone:
lesley.morgan@ndorms.ox.ac.uk
01865 223101
emma.roberts@ndorms.ox.ac.uk
01865 223103
Fax:
www.ouh.nhs.uk/kadoorie/
01865 223102
louise.spoors@ouh.nhs.uk
susanna.symonds@ouh.nhs.uk
liz.tutton@ouh.nhs.uk
keith.willett@ndorms.ox.ac.uk
julie.wright@ouh.nhs.uk
Selected Recent References
Griffin D, Parsons N, Shaw E,
Kulikov Y, Hutchinson C,
Thorogood M, Lamb S.
Operative versus non-operative
treatment for closed, displaced, intraarticular fractures of the calcaneus:
randomised controlled trial. BMJ
2014;349:g4483 doi: 10.1136/
bmj.g4483.
Keene D, Williamson E, Bruce
J, Willett K, Lamb S.
Early Ankle Movement Versus
Immobilization in the Postoperative
Management of Ankle Fracture in
Adults: A Systematic review and
Meta-analysis. The journal of
orthopaedic and sports physical
therapy. 2014 Aug:1-40.
Chesser T, Fox R, Harding K,
Barnfield S, Halliday R,
Greenwood R, Javaid K, Willett K,
Lamb S.
The administration of intermittent
parathyroid hormone affects functional
recovery from pertrochanteric
fractured neck of femur: A protocol for
a prospective mixed method pilot study
with randomisation of treatment
allocation and blinded assessment
(FRACT) BMJ Open 2014; 1(4) doi:
10.1136/bmjopen-2013-004389.
Willet K, Keene D, Morgan L,
Gray B, Handley R, Chesser T,
Pallister I, Tutton E, Knox C,
Lall R, Briggs A, Lamb S.
Ankle Injury Management (AIM):
design of a pragmatic multi-centre
equivalence randomised controlled
trial comparing Close Contact
Casting to Open surgical Reduction
and Internal Fixation in the
treatment of unstable ankle
fractures in patients >60 years BMC
musculoskeletal disorders. 2014:79
doi: 10.1186/1471-2474-15-79.
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