orthopaedic research case discussions

May 4, 2020

These cases are are to get you to starting thinking and ask yourself questions about the following clinical cases and then relate these to the orthopaedic research!

This webinar featuring Dan Perry, Xavier Griffin, and Pete Bates is all about orthopaedic research. They discuss these cases during the webinar, and explain common research terms such as what is equipoise? What is a community equipoise? What is a pragmatic trial?

Case 1 - Ankle Fracture

42 years old male, missed the bottom step at home - twisting injury.

Otherwise fit and well - no co-morbidities. Closed injury. Reduced in ED. CT was done and showed a small avulsion from the posterior mall but minimal joint involvement.

These questions are about establishing equipoise. Please select the option below that most closely reflects your opinion around treatment for this fracture. Please be as honest as you can - we want your REAL opinions.

Sorry, there are no polls available at the moment.

You are approached to take part in an NIHR-funded, randomised, controlled trial comparing internal fixation to non-op treatment in a TCC for this fracture type. Which of the following most closely reflects your honest opinion?

Your response to an RCT

I'm a non-op person normally (TCC). I'm not loving the idea of surgery here and so I wouldn't recruit to the trial - politely say no thanks.
I'm a non-op person normally (TCC) but I would be happy to recruit. I'm pretty sure the study will show TCC to be superior, which will mean that I was right all along!
I'm an internal fixation person normally but I would be happy to recruit. I'm pretty sure the study will show ORIF to be superior, which will mean that I was right all along!
I genuinely do not know which is the better treatment, op or non-op. I would therefore strongly welcome a trial of this type and would happily recruit patients with this fracture type into it.
I usually ORIF. Non op would be a departure from my normal treatment. I will decline to recruit.
I am an internal fixation person. There is no way on God's earth that I would consider putting this patient into such a ridiculous and frankly dangerous trial. I'm furious just thinking about it.

View Results

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Video takeaway message from Xavier Griffin after next case

Case 2 - Hip Fracture

Many have argued over the years that there are some intracapsular hip fractures that might actually do best with non-operative treatment.

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You are approached to recruit patients to an NIHR-funded RCT, comparing operative vs non-operative treatment of intracapsular hip fractures

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Case 3 - Paediatric distal third forearm

8 year old male. Fall from monkey bars. NV intact. Comfortable in backslab. Previously fit and well.

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You are approached to take part in an NIHR-funded, randomised, controlled trial comparing MUA +/- K-wires (+/- ORIF) to non-op treatment in a cast for this fracture type. Which of the following most closely reflects your honest opinion?

Your response to an RCT

I'm a non-op person normally. I'm not loving the idea of surgery here and so I wouldn't recruit to the trial - politely say no thanks.
I'm a non-op person normally but I would be happy to recruit. I'm pretty sure the study will show non-operative treatment to be superior, which will mean that I was right all along
I'm an internal fixation person normally but I would be happy to recruit. I'm pretty sure the study will show ORIF to be superior, which will mean that I was right all along
I genuinely do not know which is the better treatment, op or non-op. I would therefore strongly welcome a trial of this type and would happily recruit children with this fracture type into it.
Normally this get's MUA +/- K-wires (+/- ORIF). Non-op treatment of this fracture (leaving off-ended) is a departure from my normal practice & patients may come to harm. I will decline to recruit
OMG, not another ridiculous pragmatic trial trying to get us to treat things non-operatively that we know need fixing. If I had my way, I have the researcher in charge of this study clapped in irons.

View Results

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Case 4 - Paediatric distal radius

7 years old female. Skateboard injury. NV intact. Comfortable in backslab. Previously fit and well.

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You are approached to take part in an NIHR-funded, randomised, controlled trial comparing MUA +/- K-wires (+/- ORIF) to non-op treatment in a cast for this fracture type. Which of the following most closely reflects your honest opinion?

Your response to an RCT

I'm a non-op person normally. I'm not loving the idea of surgery here and so I wouldn't recruit to the trial - politely say no thanks.
I'm a non-op person normally but I would be happy to recruit. I'm pretty sure the study will show non-operative treatment to be superior, which will mean that I was right all along
I'm an internal fixation person normally but I would be happy to recruit. I'm pretty sure the study will show ORIF to be superior, which will mean that I was right all along
I genuinely do not know which is the better treatment, op or non-op. I would therefore strongly welcome a trial of this type and would happily recruit children with this fracture type into it.
Normally this get's MUA +/- K-wires (+/- ORIF). Non-op treatment of this fracture (leaving off-ended) is a departure from my normal practice & patients may come to harm. I will decline to recruit
OMG, not another ridiculous pragmatic trial trying to get us to treat things non-operatively that we know need fixing. If I had my way, I have the researcher in charge of this study clapped in irons.

View Results

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How can I get into orthopaedic research?

Jamila Kassam is the Orthopaedic research lead at Barts Health NHS Trust.

Jamila answers the common questions that she gets asked by trainees interested in getting into research.

NIHR Good Clinical Practice https://www.nihr.ac.uk/health-and-care-professionals/learning-and-support/good-clinical-practice.htm NIHR

Academic Training Pathway - https://www.nihr.ac.uk/explore-nihr/academy-programmes/integrated-academic-training.htm

NIHR RDS London - research resources - https://www.rds-london.nihr.ac.uk/resources/

PRISMA guidelines for systematic reviews - http://www.prisma-statement.org/

Now watch the orthopaedic research webinar to take these short messages further and learn more about orthopaedic research. Or head over the to the webinars page to explore the up coming webinars, and past webinars.