Professor Marilyn James, Professor of the Eoconomics of Health and Social Policy, is part of a team of researchers led by Mr Damian McClelland from University Hospital of North Staffordshire NHS Trust who have been awarded a research grant by the National Institute for Health Research. The grant, worth over £44,000, will commence in January 2012 and investigate "Fracture Fixation Ankle Surgery; Use of Tourniquet & Early Recovery Management Trial".
Ankle fractures are common and often require an operation to fix the broken bone. During surgery it is standard practice to use a tourniquet, which is a band placed tightly around the thigh to stop the blood supply to the joint. Tourniquets can make surgery quicker because the surgeon is able to operate in a blood-less field. However, some evidence suggests that using a tourniquet may delay a patient’s recovery leading to a longer stay in hospital and may also increase the risk of complications such as infection. However, the current evidence is not strong enough to decide whether or not to use tourniquets.
We propose conducting a two-stage trial to address both these areas of uncertainty thus avoiding the additional time, cost and burden on patients of running two separate trials. A total of 208 patients requiring surgery for a fractured ankle will be randomly allocated to have their operation either with or without the use of a tourniquet (for which the primary outcome will be length of hospital stay). The same patients will then be randomised to post-operative rehabilitation involving early weight-bearing and ankle motion without a plaster cast or early weight-bearing with a plaster cast (for which the primary outcome will be functional status). Patients will be followed up at 6 weeks, 3 and 6 months. Hospital resources such as theatre time, hospital visits, and personal costs to patients (e.g. loss of income) will be measured over a six-month period in order to identify the most cost-effective methods.
Posted on Tuesday 22nd November 2011