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Trauma Research

Current Studies

Overviews of ongoing and completed studies conducted by MetroHealth trauma experts.

Polytrauma: EAC

A prospective protocol for Early Appropriate Care is being studied to determine rates of early complications, treatment costs, and functional outcomes versus our retrospective cohort and versus a damage control protocol at other trauma centers.

Principal Investigator: Heather Vallier, MD
Co-Investigators: Timothy Moore, MD; John Como, MD; Xiaofeng Wang, PhD; Charles Smith, MD; Karl Wagner, MD; Patricia Wilczewski, BSN
Coordinator: Mary Breslin

OTA OFC

The purpose of this project is to see if the classification assigned to open fractures is related to their short term outcome. This will be a retrospective, short-term, multi-center, cohort study of 300 patients in trauma centers across North America and Europe. Sites will be asked to identify and enroll a consecutive series of patients who are admitted with an open fracture over a four month period. Our goal is to examine the ability of the OTA_OFC to predict short-term treatment variables and endpoints (e.g., amputation, infection, wound/flap healing). Our second goal is to analyze the available data to determine if the OTA_OFC can be shortened.
 
Principal Investigator: Ari Levine, MD
Coordinator: Mary Breslin

Distal Femur Fractures

Locked plating is a new technology currently used to treat fractures of the distal femur. It allows the surgeon to lock screws into the plate for more rigid fixation. The 95-degree angled blade plate is another option that provides rigid fixation for distal femur fractures. This study compares the clinical outcomes of patients treated with either plate in a prospective, randomized trial. We will determine if the new technology provides any improvement in outcome for the patient and also include a cost analysis of the two groups.

Principal Investigator: Heather Vallier, MD
Co-Investigator: Brendan Patterson, MD
Coordinator: Mary Breslin


F.A.I.T.H. Study

Worldwide, 4.5 million people are disabled from hip fractures yearly, with an expected increase to 21 million people living with disability in the next 40 years. This is an international, multi-center, randomized trial that will prospectively review Fixation using Alternative Implants for the Treatment of Hip Fractures (FAITH) by comparing sliding hip screws and cancellous screws on revision surgery rates and quality of life.

Principal Investigator: Heather Vallier, MD
Coordinator: Mary Breslin

Sacrum Fracture Study

Sacrum fractures are common after both low energy falls and high speed, high energy events. Implications of minor sacrum malunion of overall function are poorly understood. Controversy also exists regarding the benefit of surgery for some sacrum fractures. This prospective, multicenter study will follow patients who have had sacrum fractures, reviewing their healing and return to function over the first two years.
 
Principal Investigator: Heather Vallier, MD
Coordinator: Mary Breslin

METRC Studies

The Major Extremity Trauma Research Consortium (METRC) consists of a network of clinical centers (both civilian and military) and one data-coordinating center that will work together with the Department of Defense to conduct multi-center clinical research studies relevant to the treatment and outcomes of orthopaedic trauma. MetroHealth Medical Center is one of the core civilian trauma centers that will participate in a variety of studies in order to help identify and address critical issues challenging the recovery of trauma patients. The overall goal of METRC is to produce the evidence needed to establish treatment guidelines for the optimal care of the wounded warrior and ultimately improve the clinical, functional and quality of life outcomes of both service members and civilians who sustain high energy trauma.

METRC: Bioburden

The primary objective of this study is to characterize the contemporary extremity wound “bioburden” at the time of definitive wound coverage or closure of severe extremity wounds employing new polymerase chain reaction PCR technology. We will also determine the relationship of subsequent infections to the initial bioburden screen as defined by both PCR technology and standard microbiology techniques.
 
Principal Investigator: Heather Vallier, MD
Coordinator: Mary Breslin and Michelle Fasulko

METRC: FIXIT

Severe open tibia (shin) bone fractures are common military injuries and historically have high poor outcomes due to destroyed bone and soft tissue, and high rates of infection and other complications. There are two ways to treat these injuries but the best treatment is not known. One way is to use “internal fixation” where the broken bone is fixed by placing a nail down the middle of the bone or a plate on top of the bone but under the skin. The other way is to use “external ring fixation” where the broken bone is fixed using pins in the bone attached to rings and rods outside of the leg. Both treatments are currently used in trauma centers throughout the United States to treat severe tibia fractures, but we do not know which treatment is best. This study is designed to better understand the two treatments in terms of bone healing, infections, other complications and costs.

Principal Investigator: John Sontich, MD
Coordinator: Mary Breslin and Michelle Fasulko

METRC: POvIV

This study will compare the effectiveness and costs of oral versus intravenous antibiotics in treating early infections which may occur after plate treatment of fractures in the arm or leg.

Principal Investigator: Heather Vallier, MD
Coordinator: Mary Breslin and Michelle Fasulko

METRC: OUTLET

This prospective study will assess the functional outcomes after severe ankle and foot injuries. Information about pain and other complications related to these injuries will be studied. Patients will complete some physical performance tests and answer questions about their function and abilities one year or more after their injury.

Principal Investigator: Heather Vallier, MD
Coordinator: Mary Breslin and Michelle Fasulko

METRC: TCCS: Trauma Collaborative Care Study

The Trauma Survivor Network has developed online and other resources to educate and empower patients and families after trauma. MetroHealth is one of six US trauma centers which have initiated the TSN program, and other resources, including a recovery coordinator. Multiple support groups and educational classes are offered. The TCCS study will compare the effectiveness and costs of this program with control hospitals who do not have such interventions in place.

Principal Investigator: Heather Vallier, MD
Coordinator: Mary Breslin and Michelle Fasulko
Trauma Survivor Network Coordinator: Sarah Hendrickson

METRC: pTOG

High energy tibia fractures frequently require multiple procedures to heal. Bone morphogenic proteins are a family of proteins that enhance bone growth. This study will compare the effectiveness and costs of using BMP (versus traditional methods) for certain types of high energy tibia fractures with associated bone loss.

Principal Investigator: Heather Vallier, MD
Coordinator: Mary Breslin and Michelle Fasulko

METRC: TAOS

The primary objective of this study is to compare levels of impairment and functional outcomes for patients undergoing a transtibial amputation and randomized to receive an endbearing tibia-fibula synostosis (Ertl procedure) versus a standard posterior flap procedure (Burgess procedure). Secondary objectives are to 1) compare the fit and the alignment of the prosthesis together with levels of comfort and satisfaction between treatment groups; and 2) compare rates of re-hospitalizations for complications, resource utilization, and overall treatment costs for patients undergoing a below the knee amputation who are randomized to receive an end-bearing tibia-fibula synostosis versus a standard posterior flap procedure.

Principal Investigator: Heather Vallier, MD
Coordinator: Mary Breslin and Michelle Fasulko


Publications

Bibliographic body of published work by MetroHealth trauma experts.

Vallier HA, Wang X, Moore TA, Wilber JH, Como JJ. Timing of orthopaedic surgery in multiply-injured patients: Development of a protocol for Early Appropriate Care, Journal of Orthopaedic Trauma, 27:543-551, 2013.

Vallier HA, Reichard SG, Moore TA. A new look at the Hawkins’ classification for talar neck fractures. Which features of injury and treatment are predictive of osteonecrosis? Journal of Bone and Joint Surgery, in press, 2013.

Vallier HA, Cureton BA, Patterson BM. Factors affecting revenue from management of pelvis and acetabulum fractures, Journal of Orthopaedic Trauma 27:267-274, 2013.

Vallier HA, Super DM, Moore TA, Wilber JH. Do patients with multiple system injury benefit from early fixation of unstable axial fractures? The effects of timing of surgery on initial hospital course, Journal of Orthopaedic Trauma 27:405-412, 2013.

Nahm NJ, Como JJ, Vallier HA. The impact of major operative fractures in blunt abdominal injury. Journal of Trauma 74:1307-1314, 2013.

Vallier HA, Cureton BA, Patterson BM. Factors affecting functional outcomes after distal tibia fractures, Journal of Orthopaedic Trauma 26:178-183, 2012.

Vallier HA, Cureton BA, Schubeck D. Functional outcomes in women after high energy pelvic fracture. Journal of Orthopaedic Trauma 26:296-301, 2012.

Vallier HA, Cureton BA, Schubeck D. Pregnancy outcomes after pelvic fracture, Journal of Orthopaedic Trauma 26:302-307, 2012.

Vallier HA, Cureton BA, Schubeck D. Pelvic ring injury is associated with dyspareunia in women. Journal of Orthopaedic Trauma 26:308-313, 2012.

Vallier HA, Immler W. Comparison of the 95-degree angled blade plate and the locking condylar plate for the treatment of distal femoral fractures, Journal of Orthopaedic Trauma 26:327-333, 2012.

Ahmadinia K, Smucker B, Nash CL, Vallier HA. Radiation exposure in trauma patients has increased over time, Journal of Trauma 72:410-415, 2012.

Vallier HA, Fitzgerald SP, Beddow M, Sontich JK, Patterson BM. Osteocutaneous pedicle flap transfer for salvage of transtibial amputation after severe lower extremity injury, Journal of Bone and Joint Surgery 94A:447-454, 2012.

Nahm NJ, Vallier HA, Patterson BM. The impact of injury severity and transfer status on reimbursement for care of femoral fractures, Journal of Trauma 73:957-965, 2012.

Nahm NJ, Vallier HA. Timing of definitive treatment of femoral shaft fractures in patients with multiple injuries: A systematic review of randomized and nonrandomized trials, Journal of Trauma 73:1046-1063, 2012.

Vallier HA, Patterson BM, Sontich JK. Surgical technique for: Osteocutaneous pedicle flap transfer for salvage of transtibial amputation after severe lower extremity injury, Journal of Bone and Joint Surgery Essential Techniques 2:1-12, 2012.

Vallier HA, Cureton BA, Patterson BM. Factors affecting functional outcomes after distal tibia fractures, Journal of Orthopaedic Trauma, in press, 2011.

Vallier HA, Immler W. Comparison of the 95-degree angled blade plate and the locking condylar plate for the treatment of distal femoral fractures, Journal of Orthopaedic Trauma, in press, 2011.

Vallier HA, Cureton BA, Schubeck D. Functional outcomes in women after high energy pelvic fracture. Journal of Orthopaedic Trauma, in press, 2011.

Vallier HA, Cureton BA, Schubeck D. Pregnancy outcomes after pelvic fracture, Journal of Bone and Joint Surgery, epub ahead of print, 2011.

Vallier HA, Cureton BA, Schubeck D. Pelvic ring injury is associated with dyspareunia in women. Journal of Orthopaedic Trauma, epub ahead of print, 2011.

Vallier HA, Fitzergerald A, Stephen P, Beddow M, Sontich JK, Patterson BM.  Osteocutaneous Pedicle Flap Transfer for the Salvage of Below Knee Amputation After Severe Lower Extremity Injury.  in press  Journal of Bone and Joint Surgery 2011

Vallier HA, Cureton BA, Patterson BM. Randomized, prospective comparison of plate versus intramedullary nail fixation for distal tibia shaft fractures. Journal of Trauma 71:175-185, 2011.

Huang JI, Paczas M, Hoyen HA, Vallier HA. Functional outcome after open reduction and internal fixation of intraarticular fractures of the distal humerus in the elderly. Journal of Orthopaedic Trauma 25: 259-265, 2011.

Nahm N, Como JJ, Wilber JH, Vallier HA. Early appropriate care: definitive stabilization of femoral fractures within 24 hours is safe in most multiply-injured patients, Journal of Trauma 71:175-185, 2011.

Vallier HA, Cureton BA, Eckstein C, Oldenburg FP, Wilber JH. Early definitive stabilization of unstable pelvis and acetabulum fractures reduces morbidity, Journal of Trauma. 69:677-684, 2010.

Vallier HA, Prokuski LJ, Nash, CL, Patterson BM. Effects of resident work hours restrictions on education and patient care, Current Orthopaedic Practice, 20:77-83, 2009.

Vallier HA, Patterson BM. Economic impact of orthopaedic trauma care on hospitals and hospital systems. Curr Orthop Prac. 20:475-481, 2009.

Gillespie R, Ramachandran V, Lea E, Vallier HA. Biomechanical evaluation of three-part proximal humerus fractures: A cadaveric study. Orthopaedics. 32:1-6, 2009.

Malone KJ, Matuszak S, Greene PW, Mayo DB, The effect of epinephrine lavage on post operative blood loss following total knee arthroplasty. Orthopaedics 2009; 32(2): 100-03.

Vallier HA, Le TT, Bedi A. Radiographic and clinical comparison of distal tibia shaft fractures (4 to 11cm proximal to the plafond): Plating versus intramedullary nailing, Journal of Orthopaedic Trauma, 22:307-311, 2008.

Friess DM, Attia A, Vallier HA. Locking plate fixation for fractures of the proximal humerus: A comparison with other techniques, Orthopaedics, 2008.

Vallier HA, Patterson BM, Meehan C, Lombardo T. Orthopaedic traumatology: The hospital side of the ledger, Journal of Orthopaedic Trauma, 22:221-226, 2008.

Martineau PA, Waitayawinyu T, Malone KJ, Hanel DP, Trumble TE. Volar Plating of 4 Part Intraarticular Distal Radius Fractures: Biomechanical Evaluation of Locking Screw and Locking Smooth Peg Configurations.  J Hand Surg 2008; 33(6):827-34.

Vallier HA, Le TT, Bedi A. A comparison of plate versus intramedullary nail fixation for distal tibia fractures, Journal of Orthopaedic Trauma, 22:307-311, 2008.

Patterson BM, Agel J, Swiontkowski MF, MacKenzie EJ, Bosse MJ, the LEAP Study Group. Knee Dislocations With Vascular Injury: Outcomes in the Lower Extremity Assessment Project (LEAP) Study. Journal of Trauma. 63(4):855-858, 2007.

Liu RW, Mehta P, Fortuna S, Armstrong DG, Cooperman DR, Thompson, G.H., Gilmore, A.: A Randomized Prospective Study of Music Therapy for Reducing Anxiety During Cast Room Procedures. J. Pediatr. Orthop., 27 #7, Oct./Nov. 2007.

Goyal KS, Skalak AF, Marcus RE, Vallier HA, Cooperman DR. Analysis of "anatomic" periarticular tibial plate fit on normal adults, Clinical Orthopaedics and Related Research 461:245-257, 2007.

Huang JI, Toogood P, Chen MR, Wilber JH, and Cooperman DR: Clavicular Anatomy and the Applicability of Precontoured Plates. The Journal of Bone and Joint Surgery Am., 89A:2260-2265, 2007.

Vallier HA. State of the Art: Treatment of Proximal Humerus Fractures. Journal of Orthopaedic Trauma, 21:469-476, 2007.
Wera GD, Sontich JK. Tibiotalar arthrodesis using a custom blade plate. J Trauma. 2007 63:1279-82.

Anderson PA, Moore TA, Davis KW, Molinari RW, Resnick DK, Vaccaro AR, Bono CM, Dimar JR 2nd, Aarabi B, Leverson G.  Cervical spine injury severity score. Assessment of reliability. J Bone Joint Surg Am. 2007 89:1057-65.

Vallier HA, Hennessey TA, Sontich, JK, Patterson BM. Failure of LCP Condylar Plate fixation in the distal part of the femur: A report of six cases, Journal of Bone and Joint Surgery 88A:846-853, 2006.

Vallier HA, Sontich, JK, Patterson BM. Letter to the Editor, regarding: Failure of LCP Condylar Plate fixation in the distal part of the femur: A report of six cases, Journal of Bone and Joint Surgery 88A:2541-2542, 2006.

Archdeacon MT, Anderson R, Harris AM, Wilber JH.Concomitant Fractures of the Acetabulum and Spine: A Retrospective Review of Over 300 Patients. Journal of Trauma 60:609-612, 2006.

Eubanks JD, Gilmore A, Bess S, Cooperman DR. Clearing the Pediatric Cervical Spine Following Injury. J Am Acad Orthop Surg. 14, 552-564, 2006.

Harris AM, Patterson BM, Sontich JK, Vallier HA. Results and outcomes after operative management of tibial plafond fractures; comparison of internal and external fixation. Foot and Ankle International, 27:256-265, 2006.

Stover MD, Summers HD, Ghanayem AJ, and Wilber JH. Three-dimensional Analysis of Pelvic Volume in an Unstable Pelvic Fracture. Journal of Trauma 61:905-908, 2006.

Kilgore KL, Hart RL, Montague FW, Bryden AM, Keith MW, Hoyen HA, Sams CJ, Peckham PH. An implanted myoelectrically-controlled neuroprosthesis for upper extremity function in spinal cord injury. Conf Proc IEEE Eng Med Biol Soc. 2006; 1:1630-3.

Moore TA, Vaccaro AR, Anderson PA. Classification of Lower Cervical Spine Injuries. Spine. 31(11 Suppl):S37-43; discussion S61, 2006 May 15.

Bredbenner TL, Snyder SA, Mazloomi FR, Le T, Wilber RG. Subtrochanteric fixation stability depends on discrete fracture surface points, Clin Orthop Rel Res. 432:217-225, 2005.

Castillo RC, Bosse MJ, MacKenzie E J, Patterson BM. LEAP Study Group: Impact of Smoking on Fracture Healing and the Risk of Complications in Limb-Threatening Open Tibia Fractures. Journal Orthopaedic Trauma 19(3):151-157, 2005.

Teng, AL, Huang JL, Wilber RG, Wilber JH. Treatment of compartment syndrome: transverse fasciotomy as an adjunct to longitundinal dermatofasciotomy, an in vitro study. J Orthop Trauma 19:422-427, 2005.

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  • © Copyright 2002 - The MetroHealth System
  • 2500 MetroHealth Drive|Cleveland, OH 44109|(216) 778-7800
  • All Rights Reserved.