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NIHR Signal Negative pressure dressings are no better than standard dressings for open fractures
Negative pressure wound dressings are neither more nor less effective than standard wound dressings for severe open fractures of the lower leg. Any difference between groups was neither clinically important nor statistically significant. The outcomes included self-rated disability at one year, quality of life and deep surgical site infections at one month which occurred in around 7-8% in each group. Open fractures of the leg, where the broken bone is exposed by the original injury or has burst ...
NIHR Signal Keyhole surgery is more effective than physiotherapy for hip impingement
Keyhole surgery to reshape the joint surfaces in people with hip impingement improves hip-related quality of life more than physiotherapy. In hip impingement, there is a painful restriction of the smooth movement of the ball of the femur inside the cup (acetabulum) of the pelvis. It mainly affects younger, active people. Observational studies have supported the use of keyhole surgery (arthroscopy), but there was a lack of high-quality evidence. This NIHR-funded study is the first trial to compa...
NIHR Signal People with osteoarthritis can benefit from exercise but may harbour myths about safety
Programmes that show people with osteoarthritis how to exercise safely may slightly improve pain scores, self-belief and social function, but participants also report the myth that discomfort while exercising indicates on-going harm. The review combines evidence from 21 randomised controlled trials evaluating exercise in hip or knee osteoarthritis with 12 studies where people receiving the intervention were interviewed about the impact of exercise on their disease. Participants were men and wom...
NIHR Signal Aspirin may be a follow-on option to prevent blood clots, starting five days after hip or knee surgery
In a recent trial, switching to low-dose aspirin was just as effective at preventing blood clots after joint replacement surgery as continuing the anti-clotting drug rivaroxaban. Six per 1,000 people taking aspirin experienced a blood clot, compared with seven per 1,000 taking rivaroxaban. Three to five per 1,000 patients experienced major bleeding with either drug. Rivaroxaban or similar drugs are usually prescribed for two or five weeks after knee or hip surgery, respectively, to reduce the r...
NIHR Signal Hospital admission rates and costs increase in line with BMI
Each 2kg/m2 rise in body mass index (BMI) above the normal-weight threshold in women aged 55-79 leads to a 5% rise in annual hospital admissions and 7% rise in healthcare costs. In England, £662 million of the annual hospital admission costs in 2013 could be attributed to overweight or obesity in women of this age group. This large study, partly funded by the NIHR, looked at over one million women participating in the NHS breast cancer screening programme. Five-year data on hospital admis...
NIHR Signal A surgical procedure for shoulder pain is less effective than previously thought
An increasingly common surgical procedure for shoulder pain, subacromial decompression, was only slightly more effective than no treatment. In the first trial of this sort, improvements in pain and function following decompression or arthroscopy (a placebo surgery) did not reach a threshold of clinical importance compared with people allocated to no treatment at all. This NIHR-funded study involved 313 people with shoulder pain that had not responded to physiotherapy and a steroid injection. Th...
NIHR Signal Two common operations to fix a broken tibia have similar outcomes
In people who had broken the lower part of their tibia (shin bone), fixation using a metal rod nailed to the insideof the bone was compared with a locking plate screwed onto the surface of the bone. There was no difference in the quality of life, disability or pain at 12 months for people who had fractures of the lower tibia fixed using either technique. NICE guidance recommends that surgery takes place within 24 hours of injury but does not mandate which type of surgery to perform. This NIHR U...
NIHR Signal Local nerve blocks can improve outcomes for people with hip fracture
Local nerve blocks around the time of hip fracture surgery reduced pain on movement within 30 minutes of injection. People had less need for opioid pain-relief and were quicker to mobilise after surgery. Also, one case of pneumonia was prevented for every seven people given pain relief using a nerve block. By injecting local anaesthetics close to the nerves to relieve pain after a hip fracture, it is hoped that the need for opioids can be reduced and people might recover more quickly. Nerve blo...
NIHR Signal New casting technique is an option for older people with ankle fracture
A new casting technique called “close contact casting” is an alternative to surgery for older people with ankle fracture. Ankle function at six months was similar in people who had casting and those who had surgery but there are some disadvantages to both that patients and surgeons could consider. This UK-based NIHR trial recruited 620 people aged over 60 years with an unstable ankle fracture that would usually be fixed with surgery. People who had a cast were less likely to have i...
NIHR Signal Ultrasound therapy doesn’t speed healing of leg fracture after surgery
Low intensity pulsed ultrasound (LIPUS), sometimes used to encourage bone fractures to heal after surgery, makes no difference to how soon people can get back to their normal activities or to the speed at which bones appear to heal on x-ray. The biggest trial of the treatment to date recruited 501 adults with a fractured tibia (shin bone) and who’d had the break fixed surgically. They were asked to use LIPUS for a year at home, or until the bone had healed. Half were given dummy equipment...
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