News

Every year, 4,500 people suffer from complex elbow injuries which can significantly affect their lives and their ability to carry our routine tasks, particularly in older patients.

Now a team of NHS surgeons and researchers from Nottingham is hoping to discover the best option for these patients, who all face complex surgery to either replace or reconstruct their elbow joint.

Surgeons at Nottingham University Hospitals (NUH) and researchers from the NIHR Nottingham Biomedical Research Centre (BRC) are leading a major £2 million UK-wide clinical trial to determine the best long-term surgical treatment in adults over the age of 60.

The FOREST Elbow Trial, funded by the National Institute for Health and Care Research (NIHR) through its Health Technology Assessment (HTA) Programme, is being co-ordinated by the University of Nottingham Clinical Trials Unit, in collaboration with clinical teams at Wrightington and Edinburgh.

Led by Professor Benjamin Ollivere, Consultant Orthopaedic and Trauma Surgeon at NUH and Co-Theme Lead for Musculoskeletal, Surgery, Inflammation & Recovery at the Nottingham BRC, the FOREST trial focuses on patients aged 60 and over with complex elbow fractures.

The trial is now open at five NHS centres and has just recruited its first patient—a key milestone in what will be one of the largest UK studies of its kind. The study aims to recruit up to 320 participants across at least 20 hospitals nationwide.

“For this group of patients, surgery is often necessary to avoid long-term disability,” said Professor Ollivere. “These fractures can be life-altering, affecting a person’s ability to carry out basic daily tasks.”

The trial compares two common surgical approaches:
• Elbow fixation, where broken bones are realigned and secured using plates and screws
• Elbow replacement, where the damaged joint is replaced with a prosthetic made of metal and plastic.

Both procedures are already used in the NHS, but it is not yet clear which leads to better long-term recovery for older adults.

“Elbow replacement offers early mobility and carries a low risk of needing further surgery but may limit the patient’s ability to lift heavy objects,” said Professor Ollivere.

“Fixation enables a more natural range of movement but comes with a higher risk of complications. Through this trial, we aim to find out which option gives patients the best chance of recovery.”

The NIHR’s HTA programme funds research to ensure new treatments are compared with standard care, helping the NHS deliver evidence-based interventions.