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CLINICAL UPDATE
WA leads the pack By A/Prof Sue Skull, Paediatrician, Clinical Epidemiologist Having a basic knowledge of research methods is key to providing the best for our patients and clients, whether it’s through undertaking clinical audits or randomised controlled trials, critically appraising the latest evidence efficiently, understanding ethical and governance issues related to research, or translating results into policy and practice. Embedding research in all aspects of clinical care is cost effective and central to evidence-based best practice. But while many clinicians are keen to be involved in research, they may not have had access to training in research methods, and can be unsure how to get started or avoid common pitfalls. The Child and Adolescent Health Service (CAHS) Research Education Program, supported by the PCH
W E S T E R N
Foundation, provides high quality, free and open-access resources designed for busy clinicians and students of any health discipline or level of experience. These include more than 20 onehour seminars across the research process, along with accompanying comprehensive handouts with additional resources, a Clinical Audit Handbook and some inhouse workshops. The seminars provide short, distilled overviews of a broad range of topics and link to other resources and available training opportunities. The program aims to improve quality, impact, efficiency and outcomes for research projects, reduce risk associated with research, and encourages the embedding of research in all areas of clinical practice.
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C L I N I C
Neurotization
N E R V E R E PA I R - A l e x O ’ B e i r n e One of the biggest advances in the repair of nerve injury is Neurotization or nerve transfer. This is the technique of splitting a healthy nerve and redirecting it to a damaged nerve so that the healthy nerve now powers both its original function and the function of the damaged nerve. This can be utilized for both motor nerves and sensory nerves and trials are underway for autonomic nerves. The application of this technique has been gradually expanding over the last 10 years and it is now used for the repair of • High or extensive peripheral nerve injury • Brachial plexus nerve injuries • Spinal cord injuries • Single level spinal root injuries The technique involves splitting up to 20% of the donor nerve and then suturing it into the recipient damaged nerve. This is usually performed on the nerve in an area that is away from the site of injury, close to the end target organ (muscle or sensory area). The advantage of this technique allows for the surgery to be performed in healthy tissue, which improves success rates up to 90% in some series, speedy recovery of the nerve, activity usually begins within 3 months, and no donor deficit.
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F I V E
M I N U T E
The program’s popularity across WA Health since it began in 2013 has grown to involve many WA health sites via video link and Telehealth. Program resources are currently used by staff and students from every major health service provider, university and research institute in WA, and increasingly more broadly throughout Australia and beyond. Access to seminars is possible on the day of delivery in person, via video conferencing on individual devices, via Telehealth linked into shared teaching spaces, or later via recordings on the CAHS website. Materials are regularly updated to reflect current national standards and changing methodologies.
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C L I N I C A L
Some of the limitations of this technique are that the procedure should be performed within six months of the injury, technically very difficult as the topographical anatomy of the peripheral nerves is still not fully known and there is significant individual variation. It can take up to one year before full recovery from the procedure, thus outcomes are uncertain for quite some time. The donor nerves are at risk and potentially the patient has a lot to lose. Some examples of nerve injuries that have been repaired • Restoring elbow extension and hand function to C6 level quadriplegics to grade 4/5 power • Restoring shoulder and elbow function to C5, 6, 7 brachial plexus injuries • Restoring dorsi flexion of the ankle in L5 radiculopathy post disc prolapse • Restoring sensation to the hand after resection of the sensory component of the median nerve • Restoring the trapezius function CN XI post neck dissection and resection for tumour Future applications of this technique are restoration of arm function after strokes. This is an exciting area in orthopaedics and nerve injuries are no longer the devastating injury they once were.
MEDICAL FORUM | INNOVATION & TRENDS ISSUE
U P D AT E
Western Orthopaedic Clinic is a multi-centre orthopaedic group, with rooms across Perth. We are committed to bringing the newest techniques and are involved in research in many areas. Phone: +61 8 9489 8700 Email: woc@wocwa.com
wocwa.com
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