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The clinical effectiveness of biological treatment adjuncts in the management of acute and un-united fractures
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Griffin, Xavier L. (2012) The clinical effectiveness of biological treatment adjuncts in the management of acute and un-united fractures. PhD thesis, University of Warwick.
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Official URL: http://webcat.warwick.ac.uk/record=b2680591~S1
Abstract
BACKGROUND
Fractures are common. The annual incidence of fresh fractures is estimated to be
3.6 per 100 people in England and Wales. Traditional management, employing nonoperative
immobilisation strategies, has been replaced by a much more operative
approach. The aim of this thesis is to understand and add to the evidence that
supports available biological adjuncts to fracture management.
EXPLORATION OF THE EVIDENCE THROUGH SYNTHESIS
Several systematic reviews have been performed to review the currently available
evidence for the clinical effectiveness of biological adjuncts. Adjuncts were chosen
that are currently available for use in routine clinical practice. These reviews
particularly focused on identifying where the evidence was of poor quality or did not
exist to support such clinical applications.
These reviews found that overall the quality and breadth of the evidence was
limited. This was particularly true for the evidence to support the use of
demineralised bone matrix and platelet-rich therapies. Ultrasound and
electromagnetic induction were more established and few opportunities were
identified to further test their effectiveness.
DEVELOPMENT AND REPORTING OF A TEST OF CLINICAL EFFECTIVENESS
The development of a protocol followed, which involved determining an appropriate
experimental model in which to test one of the biological adjuncts. This protocol
reflected a determination to test the clinical effectiveness, rather than efficacy, of
platelet-rich plasma. The trial did not demonstrate a significant effect of platelet-rich
plasma in the treatment of patients with an internally fixed intracapsular fracture of
the proximal femur. The effect estimate included potentially important benefits or
harms from the treatment.
DISCUSSION
This thesis summarises the diverse evidence available concerning biological
adjuncts, proposes a protocol to test the clinical effectiveness of one, and tests this
in a pragmatic controlled trial. The challenges, exemplified in the trial reported here,
to the conduct of randomised trials of complex interventions in surgery are
highlighted and approaches to overcome these obstacles discussed.
Item Type: | Thesis (PhD) | ||||
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Subjects: | R Medicine > RM Therapeutics. Pharmacology | ||||
Library of Congress Subject Headings (LCSH): | Fractures -- Treatment -- Research | ||||
Official Date: | August 2012 | ||||
Dates: |
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Institution: | University of Warwick | ||||
Theses Department: | Warwick Medical School | ||||
Thesis Type: | PhD | ||||
Publication Status: | Unpublished | ||||
Supervisor(s)/Advisor: | Costa, Matthew L.; Achten, Juul | ||||
Sponsors: | British United Provident Association; Furlong Research Charitable Foundation | ||||
Extent: | 279 leaves : charts. | ||||
Language: | eng |
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