Chris G Moran

Nottingham University Hospitals NHS Trust, Nottigham, England, United Kingdom

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Publications (16)40.66 Total impact

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    ABSTRACT: We completed a full audit cycle to assess waiting times for inpatients with suspected occult femoral neck fracture to get MRI scan, identify the causes of delay and implement the changes to reduce the waiting times. We have proved that inpatient MRI waiting times can significantly be reduced by a targeted approach.
    Osteoporosis International 08/2014; 26(1). DOI:10.1007/s00198-014-2861-8 · 4.17 Impact Factor
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    ABSTRACT: To examine how the population with fractured neck of femur has changed over the last decade and determine whether they have evolved to become a more physically and socially dependent cohort. Retrospective cohort study of prospectively collected Standardised Audit of Hip Fractures of Europe data entered on to an institutional hip fracture registry. 10 044 consecutive hip fracture admissions (2000-2012). A major trauma centre in the UK. There was a generalised increase in the number of admissions between 2000 (n=740) and 2012 (n=810). This increase was non-linear and best described by a quadratic curve. Assuming no change in the prevalence of hip fracture over the next 20 years, our hospital is projected to treat 871 cases in 2020 and 925 in 2030. This represents an approximate year-on-year increase of just over 1%. There was an increase in the proportion of male admissions over the study period (2000: 174 of 740 admissions (23.5%); 2012: 249 of 810 admissions (30.7%)). This mirrored national census changes within the geographical area during the same period. During the study period there were significant increases in the numbers of patients admitted from their own home, the proportion of patients requiring assistance to mobilise, and the proportion of patients requiring help with basic activities of daily living (all p<0.001). There was also a twofold to fourfold increase in the proportion of patients admitted with a diagnosis of cardiovascular disease, renal disease, diabetes and polypharmacy (use of >4 prescribed medications; all p<0.001). The expanding hip fracture population has increasingly complex medical, social and rehabilitation care needs. This needs to be recognised so that appropriate healthcare strategies and service planning can be implemented. This epidemiological analysis allows projections of future service need in terms of patient numbers and dependency.
    BMJ Open 04/2014; 4(4):e004405. DOI:10.1136/bmjopen-2013-004405 · 2.06 Impact Factor
  • Age and Ageing 10/2013; 42(6). DOI:10.1093/ageing/aft149 · 3.11 Impact Factor
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    ABSTRACT: The aim of this study was to compare the outcomes of displaced distal radial fractures treated with a volar locking plate with the results of such fractures treated with a conventional method of closed reduction and percutaneous wire fixation with supplemental bridging external fixation when required. Our aim was to ascertain whether the use of a volar locking plate improves functional outcomes. A single-center, pragmatic, randomized controlled trial was conducted in a tertiary care institution. One hundred and thirty patients (eighteen to seventy-three years of age) who had a displaced distal radial fracture were randomized to treatment with either a volar locking plate (n = 66) or a conventional percutaneous fixation method (n = 64). Outcome assessments were conducted at six weeks, twelve weeks, and one year. Outcomes were measured on the basis of scores on the Patient Evaluation Measure (PEM) and QuickDASH questionnaire (a shortened version of the Disabilities of the Arm, Shoulder and Hand, or DASH, Outcome Measure), EuroQol-5D (EQ-5D) scores, wrist range of motion, grip strength, and radiographic parameters. The rate of follow-up at one year was 95%. Patients in the volar locking-plate group had significantly better PEM and QuickDASH scores and range of motion at six weeks compared with patients in the conventional-treatment group, but there were no significant differences between the two groups at twelve weeks or one year. Grip strength was better in the plate group at all time points. The volar locking plate was better at restoring palmar tilt and radial height. Significantly more patients in the plate group were driving at the end of six weeks, but this did not translate to a significant difference between groups in terms of those returning to work by that time. Use of a volar locking plate resulted in a faster early recovery of function compared with use of conventional methods. However, no functional advantage was demonstrated at or beyond twelve weeks. Use of the volar locking plate resulted in better anatomical reduction and grip strength, but there was no significant difference in function between the groups at twelve weeks or one year. The earlier recovery of function may be of advantage to some patients. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
    The Journal of Bone and Joint Surgery 10/2013; 95(19):1737-1744. DOI:10.2106/JBJS.L.00232 · 4.31 Impact Factor
  • I Moppett, M Wiles, C Moran
    Anaesthesia 06/2013; 68(6):643. DOI:10.1111/anae.12242 · 3.85 Impact Factor
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    Injury Extra 10/2012; 43(10):104. DOI:10.1016/j.injury.2012.07.292
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    ABSTRACT: hip fracture represents a huge medical, social and financial burden on patients, their carers and the health and social care systems. For survivors, return to their own home may be a key outcome. The Nottingham Hip Fracture Score (NHFS) is a validated score, based on admission characteristics, for predicting 30-day and 1-year mortality that may be of benefit in predicting return-to-home, directly from the acute orthopaedic ward. to assess the utility of the NHFS as a predictor of return-to-home in patients following hip fracture. the NHFS was calculated for all patients admitted from their own home and the correlation between the NHFS and eventual return-to-home was calculated, as well as the probability of discharge by within 7, 14 and 21 days. a total of 6,123 patients were available for analysis. Of which, 3,699 (60%) were discharged from acute hospital to their own home. Increasing NHFS was negatively correlated with eventual return-to-home (r(2) = 0.949) and with the proportion of patients discharged back to their own home at 7, 14 and 21 postoperative days, respectively (r(2) = 0.84, 0.94, 0.96, respectively). the NHFS is a reliable tool for predicting return-to-home. It may be useful for discharge planning, and for the design of future research trials.
    Age and Ageing 11/2011; 41(3):322-6. DOI:10.1093/ageing/afr142 · 3.11 Impact Factor
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    ABSTRACT: This study aims to assess the mortality associated with hip fracture at 5 years in a geriatric population, and evaluate the influence of age, cognitive state, mobility and residential status on long term survival after hip fracture. A prospective audit was carried out of all patients with a hip fracture admitted to a university hospital over a 4 year period. Data from 2640 patients were analysed and multivariate analysis used to indicate the important variables predicting mortality. Patients fulfilling the criteria of age<80 years, Abbreviated Mental Test Score (AMT)≥7/10, independently mobile and admitted from own home were put into group A (low risk group). Patients not meeting the criteria were placed into group B (high risk group). 2640 patients fitted the inclusion criteria, 482 in group A and 2158 in group B. 850 patients (43.1%) died in their first year following hip fracture. 302 patients (63%) of group A were still alive at 5 years in comparison with only 367 (17%) of group B. Overall, 669 (25%) patients survived for 5 years. Increased survival was shown for the following variables: age<80 years RR 5.27 (p<0.01), AMT≥7/10 RR 6.03 (p<0.01), independent mobility RR 2.63 (p<0.01) and admitted from own home RR 4.52 (p<0.01). These findings will allow for early recognition of those patients with an increased chance of long-term survival following hip fracture. Such patients may be suitable for surgical treatment, such as total hip replacement, which has a good long-term outcome.
    Injury 11/2011; 42(11):1253-6. DOI:10.1016/j.injury.2010.12.008 · 2.46 Impact Factor
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    ABSTRACT: Recent studies have recommended the use of cephalo-medullary devices for the treatment of reverse oblique intertrochanteric femoral fractures (Orthopaedic Trauma Association/Arbeitsgemeinschaft für Osteosynthesefragen, OTA/AO 31-A3). Both the proximal femoral nail (PFN) and the gamma nail (GN) have shown good outcome results but the results of treatment with the intramedullary hip screw (IMHS) have not been reported in the literature. Our aim was to review the outcomes of these unstable fractures treated with the IMHS implant at our institute. Between 1999 and 2008, 6724 consecutive hip fractures were treated at our institute. There were 115 reverse oblique intertrochanteric fractures and 63 of these were treated with the IMHS. We retrospectively reviewed clinical and radiological records for these fractures treated with the IMHS. Follow-up duration ranged from 1 to 6 years. Amongst the 63 patients treated with the IMHS, 57 (90.5%) fractures were reduced satisfactorily with one poorly positioned hip screw and one breach of the anterior femoral cortex. The mean operative time was 115 min, 22 patients required a blood transfusion and 20 had postoperative medical complications. The major orthopaedic complications included two cases of malrotation, three nonunions and one traumatic periprosthetic fracture with a total failure rate of 7.9%. There were four cases of distal locking bolts breaking or backing out. The 30-day mortality was 6.5%. The clinical and radiological outcomes achieved with the IMHS compare favourably to the results achieved with other cephalo-medullary devices. We consider the long IMHS a good implant for the treatment of these unstable fractures.
    Injury 10/2011; 43(6):817-21. DOI:10.1016/j.injury.2011.09.011 · 2.46 Impact Factor
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    ABSTRACT: BACKGROUND: Approximately 70,000 patients/year undergo surgery for repair of a fractured hip in the United Kingdom. This is associated with 30-day mortality of 9% and survivors have a considerable length of acute hospital stay postoperatively (median 26 days). Use of oesophageal Doppler monitoring to guide intra-operative fluid administration in hip fracture repair has previously been associated with a reduction in hospital stay of 4-5 days. Most hip fracture surgery is now performed under spinal anaesthesia. Oesophageal Doppler monitoring may be unreliable in the presence of spinal anaesthesia and most patients would not tolerate the probes. An alternative method of guiding fluid administration (minimally-invasive arterial pulse contour analysis) has been shown to reduce length of stay in high-risk surgical patients but has never been studied in hip fracture surgery. METHODS: Single-centre randomised controlled parallel group trial. Randomisation by website using computer generated concealed tables. Setting: University hospital in UK. Participants: 128 patients with acute primary hip fracture listed for operative repair under spinal anaesthesia and aged > 65 years. Intervention: Stroke volume guided intra-operative fluid management. Continuous measurement of SV recorded by a calibrated cardiac output monitor (LiDCOplus). Maintenance fluid and 250 ml colloid boluses given to achieve sustained 10% increases in stroke volume. Control group: fluid administration at the responsible (blinded) anaesthetist's discretion. The intervention terminates at the end of the surgical procedure and post-operative fluid management is at the responsible anaesthetist's discretion. Primary outcome: length of acute hospital stay is determined by a blinded team of clinicians. Secondary outcomes include number of complications and total cost of care. Funding NIHR/RfPB: PB-PG-0407-13073. TRIAL REGISTRATION NUMBER: Trial registration: Current Controlled Trials ISRCTN88284896.
    Trials 09/2011; 12:213. DOI:10.1186/1745-6215-12-213 · 2.12 Impact Factor
  • C Quah, C Boulton, C Moran
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    ABSTRACT: This is the first study to use the English Indices of Multiple Deprivation 2007, the Government's official measure of multiple deprivation, to analyse the effect of socioeconomic status on the incidence of fractures of the hip and their outcome and mortality. Our sample consisted of all patients admitted to hospital with a fracture of the hip (n = 7511) in Nottingham between 1999 and 2009. The incidence was 1.3 times higher (p = 0.038) in the most deprived populations than in the least deprived; the most deprived suffered a fracture, on average, 1.1 years earlier (82.0 years versus 83.1 years, p < 0.001). The mortality rate proved to be significantly higher in the most deprived population (log-rank test, p = 0.033), who also had a higher number of comorbidities (p = 0.001). This study has shown an increase in the incidence of fracture of the hip in the most deprived population, but no association between socioeconomic status and mortality at 30 days. Preventative programmes aimed at reducing the risk of hip fracture should be targeted towards the more deprived if they are to make a substantial impact.
    The Bone & Joint Journal 06/2011; 93(6):801-5. DOI:10.1302/0301-620X.93B6.24936 · 2.80 Impact Factor
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    ABSTRACT: The hip fracture audit in Nottingham started in May 1999. Using our data, we have developed the Nottingham Hip Fracture score and are able to predict long-term survival. High quality data collection is best achieved by trained staff dedicated to data collection and analysis. We have found it very cost-effective to train audit clerks in basic data analysis and statistical techniques, allowing for rapid analysis of data. We have developed a pre-operative scoring system to predict 30-day mortality for patients undergoing hip fracture surgery and the score is calculated for all patients over 65 years. In 2008, our audit data were used to assess mortality associated with hip fractures in the geriatric population at 5 years, and to identify the influence of pre-operative age, cognitive state, mobility and residential status on long-term survival. This study allows us to identify patients with a higher chance of long-term survival and consider surgical management that may provide a better long-term outcome. The prevalence of hip fracture in our population has steadily increased over the past decade and we are able to report a fall in the 30-day mortality and the 1-year mortality with time. Using the Nottingham Hip Fracture score which identifies patients pre-operatively that are at high risk of mortality has proved extremely useful in clinical practise. The United Kingdom National Hip Fracture Database was established in 2007 to improve the quality and cost-effectiveness of care for hip fracture patients. Variation in quality of care should be reduced between units and best practise adopted throughout the health service.
    Osteoporosis International 12/2010; 21(Suppl 4):S647-53. DOI:10.1007/s00198-010-1426-8 · 4.17 Impact Factor
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    Injury Extra 12/2010; 41(12):141-142. DOI:10.1016/j.injury.2010.07.439
  • Injury Extra 12/2010; 41(12):173-173. DOI:10.1016/j.injury.2010.07.341
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    Anaesthesia 01/2010; 65(1):105-106. DOI:10.1111/j.1365-2044.2009.06184_16.x · 3.85 Impact Factor
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    ABSTRACT: Metatarsal fractures are commonly sustained during sport but little is written about metatarsal fractures in the athletic population. Demographics and definitive treatment in patients who sustained metatarsal fractures through sport were compared with an overall metatarsal fracture population. We used a prospective cohort study from a teaching hospital fracture clinic. Eighteen months of data were coded from presentation with a metatarsal fracture. Demographics, metatarsal fracture, participating sport and treatment were recorded and analysed. 791 patients presented with metatarsal fractures in an 18 month period with 74 metatarsal fractures sustained through sport. In the overall cohort group, there were 443 females and 348 males with a mean age of 44 (age range 15-91) and in the athletic population there were 6 females and 68 males with a mean age of 26 (age range 15-62). The majority of the metatarsal fractures sustained from sport were from soccer (73%), with the fifth metatarsal being the most commonly fractured. The definitive treatment in both groups appears to be similar, where the mainstay of treatment is conservative with the use of cast or early mobilisation with an elasticated support stocking. In this cohort approximately 9% of metatarsal fractures were sustained through sport, with soccer being the most common sport. Following high profile injuries to metatarsals in soccer players, it has been suggested that the incidence of these fractures is rising. Thus, it is recommended that a detailed prospective study be undertaken to specifically study the incidence, aetiology and morbidity of metatarsal fractures in the athletic population.
    The surgeon: journal of the Royal Colleges of Surgeons of Edinburgh and Ireland 05/2009; 7(2):86-8. DOI:10.1016/S1479-666X(09)80022-X · 2.21 Impact Factor

Publication Stats

65 Citations
40.66 Total Impact Points

Institutions

  • 2009–2014
    • Nottingham University Hospitals NHS Trust
      • Department of Trauma and Orthopaedics
      Nottigham, England, United Kingdom
  • 2010–2011
    • University of Nottingham
      • Centre for Sports Medicine
      Nottigham, England, United Kingdom