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Immediate weight-bearing in surgically treated ankle fractures

This study aims to understand how well surgery works for broken ankles when the person puts weight on that foot immediately after surgery to improve their mobility.

Ankle fractures are fairly common injuries with about 169 out of every 100,000 people breaking their ankle each year. They're the third most common type of fracture that people are admitted to hospital for in New Zealand. The fractures that need surgery to fix them, tend to happen more often in two main groups: younger men and older women, most often young rugby players and middle-aged women who slip or trip at home, especially on stairs or grass.

Because ankle fractures can keep people from returning to work and requiring help with their activities of daily living, it's really important to help them mobilise as soon as possible.

The results will help surgeons decide if it is safe for patients to weight bear immediately following surgery, allowing early mobilisation, independently and safely. This may shorten their hospital stay and reduce support with their activities of daily living.

This is a study in collaboration with the Department of Anatomy at the University of Otago.

We will look at the stability of the bones across the fracture after it has been fixed and put in a plaster cast or a boot.

First, we will create an ankle break (using embalmed leg specimens) and perform a fixation with metal plates and screws, mimicking a standard surgical procedure.  Then we will measure the relative movement of the broken bones when weight is applied through the limb by using a biomechanics machine that tests how stable the fixed bones are.

The team

Further information

This project has been reviewed and approved by the University of Otago Human Ethics Committee (Health). Reference: H23/118.

Osteoarthritis and surgery versus non-surgery

Osteoarthritis is a common long-term condition and is a frequent presentation in primary care (16,000 new cases recorded per year in Aotearoa).

Initial management (patient education, exercise, and weight management) often does not reach patients as recommended and this results in long-term use of pain-relieving medications before joint replacement surgery.

This type of surgery dominates the public health system costs for osteoarthritis.

Results of this study will provide insight into:

  • How to most effectively select patients who will benefit most from surgery
  • Demonstrate the unmet need for surgery
  • Make the case to funders and decision makers for funding and resourcing to increase capacity to undertake surgery

This is a study of patients coming to see a surgeon or an advanced scope physiotherapist in the community for the first time whether to have a total joint replacement or to receive non-surgical treatments for late-stage osteoarthritis.

We will look at the patients’ experiences over a period of two years from the first appointment and examine the impact of rationing surgery by evaluating the effectiveness and cost-effectiveness of total joint replacement compared to non-surgical care.

We will invite patients who attend an orthopaedic surgeon clinic appointment or an advanced scope physiotherapist in the community and those following referral to the Dunedin Hospital. We will collect patients’ perceptions of how pain affects their quality of life and functioning.

We are inviting all patients at their first appointment to complete two questionnaires. Patients will be contacted again to repeat the same questionnaires:

  • Six months following this appointment
  • 12 months after the appointment
  • 24 months after the appointment

These can be completed online with the link being sent via email, through a brief telephone call from one of the research team or posted out to be completed on paper.

The team

Further information

This project has been reviewed and approved by the University of Otago Human Ethics Committee (Health). Reference: H24/0081

Patient reported and clinical outcomes following surgery for proximal humerus fractures

Breaks (fractures) of the upper arm are the most common osteoporotic fractures after wrist and hip fractures in the elderly population. Multiple breaks can occur following an everyday fall on an outstretched arm.

This project is about studying this common shoulder injury, where doctors want to clarify the best way to do surgery.

By adding this information to what has already been learned from a similar study done at Christchurch Hospital, we plan a bigger study involving multiple hospitals in different cities. The future study will look at different surgeries for this type of fracture to determine which works best.

We are looking back at past cases where people had surgery for this type of fracture in Otago and Canterbury.

We have seen patients at Dunedin Hospital to ask about their experiences after surgery of their pain, and activities of daily living.

The data collected is being analysed and we will provide a summary of the results on this page.

The team

Further information

This project has been reviewed and approved by the University of Otago Human Ethics Committee (Health). Reference: H24/0085

A clinical audit of patients listed for total hip replacement to ascertain presence of developmental dysplasia of the hip

Developmental dysplasia is when the hip joint does not sit smoothly together. Finding and treating a hip problem early in babies can reduce the risk of the development of hip osteoarthritis later in life.

We want to know if people who have had hip replacement surgery also had undiagnosed developmental dysplasia. This is important because osteoarthritis affects:

  • How much pain people have
  • Their lifestyle
  • Increases the cost to the healthcare system in New Zealand

Checking how many people had this problem missed who either need or have had hip surgery, will give us evidence to develop ways to better find and treat a misshaped hip in infancy to reduce the risk of osteoarthritis.

We are going to look at records and x-rays from the past five years in southern New Zealand of patients waiting for or have had a hip replacement.

The patients will not be involved, and our study will not change how they are treated.

Clinicians have taken measurements on the x-ray and this information is being analysed to determine if developmental dysplasia is present. We will look at the age, sex and ethnicity to determine if particular groups of patients are affected.

The team

  • Associate Professor Sebastian Lippross
    Email sebastian.lippross@otago.ac.nz
  • Professor J Haxby Abbott
  • Mr Fraser Harrold
  • Dr Ross Wilson
  • Jane Terry
  • John Clemance

Further information

This project has been reviewed and approved by the University of Otago Human Ethics Committee (Health). Reference: H24/0084

Paediatric developmental dysplasia of the hip – A multicentre fifteen-year retrospective review of outcomes from operative and non-operative management

An additional audit of the incidence of developmental dysplasia of the hip (DDH) treated at Health New Zealand Southern over a fifteen-year period at both Dunedin and Southland Hospitals is planned. We are especially interested in children treated for DDH with Pavlik Harness and by surgery.

We will look at our screening methods, the progress with treatment and what happens for infants and children who have had surgery or non-surgical treatment. We will report on what indications there were for surgeries undertaken in infancy and surgeries required later in childhood.

We will compare the data from Otago and Southland with data from the other regions of New Zealand, specifically looking at screening methods, treatment and outcomes.

The team

Further information

This project is being reviewed by the University of Otago Human Ethics Committee (Health). Reference: H24/0181

A retrospective comparison of surgical and conservative treatment of patients with scoliosis

Scoliosis is an abnormal sideways curve in the spine. Often for an unknown reason, one side of the spine does not grow as fast as the other making it shorter and curving the spine in this direction. Scoliosis makes many activities challenging and changes a person’s appearance. Mild cases may respond to non-surgical treatments, but moderate to severe cases need surgery to prevent the curve growing, to ease symptoms, and to improve how well the person lives.

Wearing a brace is recommended for smaller curves in young people (usually 12-16 years of age). It involves making and fitting a brace that works by supporting the spine to grow straight.

Surgery involves various techniques that are changing as new ideas are researched. They include fusing the spine with rods to correct the curve or implants to guide the growth of the spine.

Each treatment option has its own advantages and things to consider.

This study will compare clinical outcomes and patient experiences between bracing, fusion surgery and implants to guide growth in the management of scoliosis. The lessons learned of the effectiveness and patient satisfaction found with current treatments will assist children in the future, with their families and their healthcare team, to make individual choices.

A second study to follow patients over five years from the time of being seen by the Spinal Unit for scoliosis treatment, is planned.

The team

  • Associate Professor Sebastian Lippross
    Email sebastian.lippross@otago.ac.nz
  • Mr Fraser Harrold
  • Mr Carl Chisholm
  • Dr Chuen Yen Hong
  • Jane Terry
  • Jaenelle Whittaker
  • Rosina Curnow

Further information

This project has been reviewed and approved by the University of Otago Human Ethics Committee (Health). Reference: H24/0200

A retrospective and prospective comparison of surgical treatment of patients for spinal conditions

Spinal surgery is a critical intervention for patients suffering from degenerative spinal disorders, trauma, or deformities. Substantial benefits of surgery include pain relief and restoring ability to do things.

Surgical choices involve various techniques that are changing over time. Each has their own advantages and things to consider, and surgery outcomes can be different depending on the individual and the type of surgery.

At the moment, there is little information on post-operative outcomes of patients treated at Dunedin Hospital. This study is important to improve our understanding of the effectiveness of current surgical practices, identifying areas for quality improvement, and to compare against national and international standards.

The lessons learned of the effectiveness and patient satisfaction found with current treatments will assist patients in the future, with their families and their healthcare team, to make individual choices.

The team

Further information

The retrospective project is being reviewed by the University of Otago Human Ethics Committee (Health). Reference: H25/0519
The prospective project is being reviewed by the Health and Disabilities Ethics Committee. Reference: 23223

A feasibility study of a mobile diabetic and vascular screening unit to improve health equity in rural Southland

We are undertaking a short trial of a mobile vascular and diabetic screening service to visit underserved and rural areas of Southland. Many people have difficulty attending appointments possibly because of language barriers, limited transport choices, living remotely or lack of local healthcare providers.

The service will be staffed by Southland health professionals who will visit local general practices, marae and the Pacific Island Advisory Charitable Trust. Participants will be offered assessments of their blood flow to their legs and feet, blood pressure, a finger-prick blood test of their diabetic state, of feet and eyes for signs of diabetes-related disease.

The main aim is to see how comfortable and willing people are to attend this mobile clinic. It will guide us to develop a larger project that can offer more assessments in a fully equipped vehicle.

The team

  • Dr Kari Clifford
    Email kari.clifford@otago.ac.nz
  • Jane Terry
  • Dr Zoe Ashley
  • Gerry Hill
  • Mr Fraser Harrold
  • Dr Jo Krysa
  • Esther Penney
  • Victoria Pemberton

Further information

The project is being reviewed by the Health and Disabilities Ethics Committee. Reference: 22751

The outcomes of Debridement Antibiotics and Implant Retention (DAIR) for acute prosthetic hip and knee infection

A review of patients over a 10-year period who had an infection treated by DAIR was undertaken to investigate how patients did following this treatment plan. The review found that DAIR is an effective strategy for elderly patients with other health issues.

The team

Further information

The project has been reviewed and approved by the University of Otago Human Ethics Committee (Health). Reference: H25/0512

Assessment of the social, clinical and economic impact of delay to surgery following an ankle fracture requiring surgical fixation

Patients with a broken ankle (fracture) may suffer long-term symptoms which can impact their lives and contribute to continuing economic costs as they recuperate and rehabilitate.

Our study aims to investigate if there are any relationships between the type of ankle fracture, any delay in having surgery, including reasons for and duration of the delay, and the costs associated with patients' rehabilitation. We will also investigate if the delay to surgery is associated with patients' sex, age and ethnicity.

The team

Further information

This project is being reviewed by the University of Otago Human Ethics Committee (Health). Reference: H25/0624

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