A phase III, multicentre, parallel-group, superiority RCT to compare upper limb specific function between elbow arthroplasty and fixation of the fracture using plates and screws in patients presenting with a fracture of the distal humerus.
Recipient organisationNIHR University College London Hospitals Biomedical Research Centre
NIHR supportRecorded as supported by this research centre
PeriodFeb 2025 — Oct 2028
In plain English
AI plain-English summary
Every year, over 4,500 adults in the UK break their elbow, and surgeons must choose between replacing the joint with an artificial one or repairing the bone with metal plates and screws—but no one knows which option works better. Both treatments are already standard practice, yet no large trial has directly compared them in older patients, who are most prone to these serious fractures. The FOREST trial will randomly assign 320 participants across at least 20 UK hospitals to receive either elbow arthroplasty or internal fixation, then track their recovery through questionnaires over one year, with a longer follow-up at 49 months. If the results show one treatment consistently leads to less stiffness, less pain, and better everyday function, surgeons will have clear evidence to guide their choice. That could spare thousands of patients from unnecessary disability and reduce the need for follow-up surgeries, quietly improving a common injury’s outcome without requiring new technology—just better information about which existing tool to use.
View original technical description
Every year, over 4,500 adults in the UK suffer a fractured elbow. These injuries are especially common among older people. The most serious fractures involve joint damage, leading to stiffness and pain that can make everyday activities difficult. For older people with this type of fracture, there are two main treatments: Elbow Arthroplasty (total or hemi): Involves replacing one or both sides of the elbow with an artificial metal and plastic joint. Internal Fixation: Involves realigning and then repairing the break using metal plates and screws. Both treatments are widely used across the UK and are not experimental. However, we do not yet know which treatment is the most effective. The FOREST trial aims to compare these two treatments to determine which is better. We will recruit 320 participants over 37 months from at least 20 different hospitals in the UK, with 160 participants in each treatment group. Participants will be randomly assigned to receive one of the two treatments. Participants will be asked to complete several questionnaires over a one-year period—at baseline, 6 weeks, 4 months, and 12 months after surgery. Additionally, there will be a longer-term follow-up about 49 months into the study. Questionnaires can be completed at routine clinic appointments, or they can be sent via text, email, or post, according to the participants preference. In summary the trial will help doctors and researchers understand which treatment offers the best outcomes for patients with fractured elbows, ultimately improving care for others in the future.
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