Trauma

It is a painful thing to admit, but the Canadians are much more advanced than pretty much anywhere else in the world...

There are not many areas where this is true (of course), but research into musculoskeletal trauma is certainly one of them. The Canadian Orthopaedic Trauma Society (COTS) has been producing high-quality, pragmatic multi-centre randomised trials since the late 90s. These have had a significant influence on clinical practice in trauma surgery around the world - from fractures of the heel to the clavicle.

Why have other countries not followed this lead? There are plenty of excuses – clinical workload, lack of funding for trauma, lack of infrastructure to support large trials etc etc. But, fundamentally it is because the rest of us have never got organised to deliver this sort of research on a big enough scale.

This may be about to change in the UK. In January, there was a meeting at the Royal College of Surgeons in London to discuss the possibility of embedding research within the fledgling Major Trauma Centre Network across the country. Professor Amar Rangan (Chief Investigator of the ground-breaking UK ProFER trial) introduced the meeting which was Chaired by Professor Chris Moran and supported by BOA President Joe Dias. There was some unnecessary ranting (mostly by me – sorry...) but the meeting covered a lot of ground. There was unanimous support for the idea that the Trauma Network offers the ideal framework to recruit patients and collect outcome data for multi-centre trials in the UK.

Lots to do, but there is finally a consensus on the way forward. Watch out Canada, we may finally be about to catch up!

Matthew Costa, Professor of Trauma and Orthopaedic Surgery, Warwick Clinical Trials Unit, UK