University Orthopaedics

Clinical Research

Congenital Dislocation of the Hip (CDH)

There is an ongoing research programme into ultrasound screening for CDH. This programme has been in place for 10 years and focuses on the secondary screening in babies at risk for CDH. Mr. Clarke is a member of the Medical Research Council's CDH Working Party and has coordinated, via the Project Management and Steering Committees, a multicentre trial of the use of ultrasound in the early treatment of CDH. The MRC working party has also commissioned surveillance studies on CDH and its early treatment. These results have been published in THE LANCET in April 1998 (351: 1149-1152).

There is also a clinical interest in early and late treatment, especially with regard to new surgical procedures. A grant application involving the latter has been accepted for major funding by the Wishbone Trust. This will involve a prospective trial of closed pelvic surgery and the later treatment of acetabular dysplasia.

Talipes (Club foot)

The clinical research programme includes the follow-up of a large cohort of children who have undergone staged surgical treatment for talipes correction. This study has stimulated further basic science studies into the growth of the foot and, in particular, chondro-epiphyseal function in the bones of the immature foot (vide infra)

Basic Scientific Research

Our main interest is the cell and molecular biology of bone and cartilage, especially:

Bone development and structure
The growth plate
The initiation of the bony epiphysis

On-going studies investigate programmed cell death (apoptosis) during chondrocyte development, growth plate function and the transdifferentiation from hypertrophic chondrocytes to bone-forming cells. These studies have been funded by the Wishbone Trust, the Oliver Bird Fund (Nuffield Foundation) and the Wessex Medical Trust.

In our laboratories, we have facilities for organ and chorio-allantoic membrane (CAM) culture of small tissue explants. We are equipped to carry out specialised histology of bone and cartilage tissues, including double immunocytochemistry with two different antibodies, autoradiography and in situ localisation of apoptotic cells. We also have facilities for investigating gene transcription using RT-PCR.

There is also easy access to an electron and confocal microscope and bone histomorphometric techniques.

	Mr. N.M.P. Clarke (Consultant Orthopaedic Surgeon and Senior Lecturer) His speciality is Paediatric Orthopaedic Surgery, on which he has published many papers. He is particularly interested in congenital dislocation of the hip (CDH) and club feet (talipes). He has written extensively on CDH and has pioneered ultrasound examination of the hip in new-born babies and the use of the Pavlik harness. In research, he is particularly interested in the mechanisms of chondro-epiphyseal growth.
	Dr. H.I. (Trudy) Roach (Principal Research Scientist and Non-clinical Lecturer) She is a cell biologist with a special interest in the cell and molecular biology of skeletal cells on which she has published many papers. Recent work concentrated on the phenomenon of transdifferentiation (when a cartilage cell becomes a bone-forming cell). She is also interested in the function of the growth plate during development and especially the role of programmed cell death/apoptosis of cartilage cells.
	Major G W Bowyer (Honorary Senior Lecturer) He is a Consultant Trauma and Orthopaedic surgeon in the British Army, working at Haslar (Gosport) as well as part time in University Orthopaedics. His major research interest has been the management of gunshot and fragment wounds. He is developing collaborative research into foot and ankle problems in the athletic and military populations.
	Nadine Hill (Research Technician) Nadine originally comes from Nova Scotia, Canada, and obtained her B.Sc. Advanced Major in Chemistry from St. Francis Xavier University in 1994. Although Nadine only joined the Department in January 1998, she is already extremely competent in carrying out all histological techniques. She is also very proficient in determining gene expression, using RT-PCR.

University Orthopaedics

Mr. N.M.P. Clarke (Consultant Orthopaedic Surgeon and Senior Lecturer)

Dr. H.I. (Trudy) Roach (Principal Research Scientist and Non-clinical Lecturer)

Major G W Bowyer (Honorary Senior Lecturer)