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Trauma Research

Current Studies

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

PREP-IT

The purpose of this study is to determine which pre-operative solution, iodine-povacrylex or chlorhexidine gluconate, is better at lowering the risk of infection and complications requiring additional surgery in patients with fractures.

Principal Investigator: Nicholas Romeo

Co-Investigator: Heather Vallier, MD

Coordinator: Joanne Fraifogl

BRT: Brake Response Time

This prospective study will examine total time to brake after fractures of the pelvis or legs. The time to weight bearing and the types and treatments of injuries will be evaluated.

Principal Investigator: Heather Vallier, MD

Coordinator: Joanne Fraifogl

PTSD: Post-traumatic Stress Disorder

PTSD is common in ortho/trauma patients. The Orthopaedic and trauma services started administering PTSD screening forms to evaluate patients at risk for PTSD. We are identifying risk factors for PTSD and providing treatment.

Principal Investigator: Heather Vallier, MD

Coordinator: Mary Breslin

RECALL

This study aims to evaluate potential effects of patient education regarding injury and treatment on patient (1) knowledge about their injury and treatment, (2) adherence to treatment recommendations, and (3) satisfaction with care.

We hypothesize an intervention consisting of education with feedback will permit better recall about injury and treatment recommendations. We also hypothesize that better recall will be associated with better patient satisfaction.

Principal Investigator: Heather Vallier, MD

Coordinator: Joanne Fraifogl

METRC Studies

The Major Extremity Trauma Research Consortium (METRC) consists of a network of clinical centers (both civilian and military) to conduct multi-center clinical research studies relevant to the treatment and outcomes of Orthopaedic trauma. 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.

Current Studies:

METRC: PREVENT CLOT

The study evaluates treatment to prevent blood clots after pelvis and leg injuries. It is a multi-center, prospective, randomized trial of subcutaneous low molecular weight heparin (LMWH) administered twice daily versus oral aspirin (ASA) taken twice daily. This trial will provide definitive evidence whether aspirin is just as effective as LMWH at preventing death and symptomatic blood clots, while potentially resulting in significantly fewer complications associated with the medicines.

Principal Investigator: Heather Vallier, MD, Jeffrey Claridge, MD

Coordinator: Joanne Fraifogl, Brianna Arko

METRC: REPAIR

The REPAIR study will improve recovery after femur (thigh bone) fracture. We will test the effectiveness of the REPAIR intervention (physical therapy (PT) plus blood flow restricted training when compared to usual care PT alone. We hypothesize that REPAIR will lead to improved long-term functional outcomes with increased muscle strength and muscle volume

Principal Investigator: Heather Vallier, MD

Coordinator: Joanne Fraifogl

METRC: EMS BIND

The objective of this study is to evaluate the effects of emergent placement of circumferential Pelvic Compression on resuscitative measures required for life-threatening pelvic ring injuries. This trial will guide the development of future efficacy trials of three advanced resuscitation techniques (surgical pelvic packing, angioembolization, and REBOA).

Principal Investigator: Heather Vallier, MD

Coordinator: Joanne Fraifogl

 

Upcoming Studies:

METRC: TOBRA

Antibiotic (vancomycin) powder placed into wounds has been shown to reduce infection. The purpose of this study is to review a new type of antibiotic power: tobramycin to compare the effect of Vancomycin powder to Vancomycin and Tobramycin powder combined in the reduction of post-fixation infections of tibial plateau and plafond fractures at high risk of infection.

Principal Investigator: Heather Vallier, MD

Coordinator: Joanne Fraifogl

METRC: SEXTANT

The proposed study is a multi-center, comparing current standard of care treatment to the SEXTANT treatment protocol in patients with Type III open fractures of the tibia and IIIB fractures of the ankle and hindfoot.

Principal Investigator: Heather Vallier, MD

Coordinator: Joanne Fraifogl

METRC: NSAIDs

The study is a randomized controlled multicenter trial looking at pain medications for patients with tibia (shin bone) fractures treated with intramedullary nail. The control group will receive standard pain management, and no nonsteroidal anti-inflammatory drugs (NSAIDs). The treatment intervention group will receive standard pain management plus up to six weeks of NSAIDs. NSAIDs give additional pain relief, but there is a small risk of bone healing being delayed. We believe that pain management with NSAIDs will result in improved pain control and lower opioid consumption but no difference in complications compared to standard of care pain management.

Principal Investigator: Heather Vallier, MD

Coordinator: Joanne Fraifogl

 

Publications

Selected bibliographic body of published work by MetroHealth trauma experts.

Polytrauma: update on basic science and clinical evidence.

Nauth A, Hildebrand F, Vallier H, Moore T, Leenen L, Mckinley T, Pape HC.Nauth A, et al. OTA Int. 2021 Feb 23.

Ankle fractures in patients over age 55 years: Predictors of functional outcome.

Simske NM, Benedick A, Audet MA, Vallier HA, Simske NM, et al. OTA Int. 2020 Jul 27.

Factors associating with surgical site infection following operative management of malleolar fractures at an urban level 1 trauma center.

Rascoe AS, Kavanagh MD, Audet MA, Hu E, Vallier HA. OTA Int. 2020 May 6.

PREVENTion of CLots in Orthopaedic Trauma (PREVENT CLOT): a randomised pragmatic trial protocol comparing aspirin versus low-molecular-weight heparin for blood clot prevention in orthopaedic trauma patients.

O'Toole RV, Stein DM, Frey KP, O'Hara NN, Scharfstein DO, Slobogean GP, Taylor TJ, Haac BE, Carlini AR, Manson TT, Sudini K, Mullins CD, Wegener ST, Firoozabadi R, Haut ER, Bosse MJ, Seymour RB, Holden MB, Gitajn IL, Goldhaber SZ, Eastman AL, Jurkovich GJ, Vallier HA, Gary JL, Kleweno CP, Cuschieri J, Marvel D, Castillo RC; METRC.O'Toole RV, et al. BMJ Open. 2021 Mar 24.

Risk factors for post-traumatic stress disorder in acute trauma patients.

Joseph NM, Benedick A, Flanagan CD, Breslin MA, Vallier HA, Joseph NM, et al. J Orthop Trauma. 2021 Mar 15.

Risk factors for nonunion after traumatic humeral shaft fractures in adults.

Olson JJ, Entezari V, Vallier H, Olson JJ, et al. JSES Int. 2020 Jul 23.

Evaluation of International Normalized Ratio Thresholds for Complications in Hip Fractures Treated With Intramedullary Nailing: Analysis of 15,323 Cases.

Du JY, Trivedi NN, Joseph NM, Sivasundaram L, Lapite I, Vallier HA, Ochenjele G.Du JY, et al. J Am Acad Orthop Surg. 2020 Dec 17.

New versus old: 95 degree angled blade plate versus distal femoral locking plate. A randomized clinical trial. Patterson BM, Breslin MA, Wadenpfuhl LK, Vallier HA, Patterson BM, et al Injury. 2020 Nov 27.

Downstream hospital system effects of a comprehensive trauma recovery services program.

DeMario B, Kalina MJ Jr, Truong E, Hendrickson S, Tseng ES, Claridge JA, Vallier H, Ho VP. DeMario B, et al. J Trauma Acute Care Surg. 2020 Dec.

Factors influencing functional outcomes following open reduction internal fixation of acetabular fractures. Joseph NM, Flanagan CD, Heimke IM, Cho E, Pothireddy S, Scarcella N, Vallier HA, Joseph NM, et al. Injury. 2020 Nov 16.

Supination adduction ankle fractures are associated with arthritis and poor outcomes.

Benedick A, Kavanagh M, Audet M, Simske NM, Vallier HA, Benedick A, et al. J Orthop Trauma. 2020 Oct 16.

Predicting Length of Stay and Readmissions After an Ankle Fracture Using a Risk Stratification Tool (STTGMA). Simske NM, Benedick A, Kavanagh MD, Vallier HA, Simske NM, et al. J Orthop Trauma. 2020 Nov.

Using the STTGMA Risk Stratification Tool to Predict Complications, Additional Operations, and Functional Outcomes After Ankle Fracture. Simske NM, Benedick A, Kavanagh MD, Vallier HA, Simske NM, et al. J Orthop Trauma. 2021 Apr 1.

Five-year Trends in Opioid Prescribing Following Orthopaedic Trauma. Flanagan CD, Joseph NM, Benedick A, Vallier HA, Flanagan CD, et al. J Am Acad Orthop Surg Glob Res Rev. 2020 Aug.

Effects of Diabetes Mellitus on Functional Outcomes and Complications After Torsional Ankle Fracture. Schmidt T, Simske NM, Audet MA, Benedick A, Kim CY, Vallier HA, Schmidt T, et al. J Am Acad Orthop Surg. 2020 Aug 15.

Factors Influencing Nonadherence to Recommended Postdischarge Follow-Up After Trauma.

Truong EI, DeMario BS, Hendrickson S, Kalina MJ Jr, Vallier HA, Tseng ES, Claridge JA, Ho VP.Truong EI, et al. J Surg Res. 2020 Dec.

Patient Satisfaction Is Improved With Exposure to Trauma Recovery Services.

Simske NM, Benedick A, Rascoe AS, Hendrickson SB, Vallier HA, Simske NM, et al. J Am Acad Orthop Surg. 2020 Jul 15.

Mental health of orthopaedic trauma patients during the 2020 COVID-19 pandemic.

Ohliger E, Umpierrez E, Buehler L, Ohliger AW, Magister S, Vallier H, Hirschfeld AG. Ohliger E, et al. Int Orthop. 2020 Oct.

Costs of Care for Low-Energy Extremity Gunshot Injuries are Reduced With Standardized Treatment. Nguyen MP, Savakus JC, Reich MS, Golob JF Jr, McDonald AA, Como JJ, Vallier HA, Nguyen MP, et al. J Orthop Trauma. 2021 Feb 1.

Implementation of a mobile app for trauma education: results from a multicenter study.

Childs BR, Breslin MA, Nguyen MP, Simske NM, Whiting PS, Vasireddy A, Vallier HA, Childs BR, et al. Trauma Surg Acute Care Open. 2020 Jun 3.

The effect of obesity on post-operative complications and functional outcomes after surgical treatment of torsional ankle fracture: A matched cohort study.

Benedick A, Audet MA, Vallier HA, Benedick A, et al. Injury. 2020 Aug.

Enhancing Trauma Patient Experience Through Education and Engagement: Development of a Mobile Application. Childs BR, Breslin MA, Andres BA, Swetz A, Hendrickson SB, Moore TA, Ho V, Vallier HA, Childs BR, et al. J Am Acad Orthop Surg Glob Res Rev. 2020 Mar 17.

Prevertebral Soft-Tissue Swelling at C7 Is Highly Sensitive for Cervical Spine Ligamentous Injury Study Type: Retrospective Cohort Study. Savakus JC, Weinberg DS, Moore TA, Vallier HA, Savakus JC, et al. J Am Acad Orthop Surg Glob Res Rev. 2020 Apr 1.

Prevalence of posttraumatic stress disorder in acute trauma patients. Joseph NM, Benedick A, Flanagan CD, Breslin MA, Simpson M, Ragone C, Kalina M, Hendrickson SB, Vallier HA, Joseph NM, et al. OTA Int. 2020 Mar 3.

Improvement in Outpatient Follow-up With a Postdischarge Phone Call Intervention.

Hendrickson SB, Simske NM, DaSilva KA, Vallier HA, Hendrickson SB, et al. J Am Acad Orthop Surg. 2020 Sep 15.

CORR Insights®: Definitive External Fixation for Anterior Stabilization of Combat-related Pelvic Ring Injuries, With or Without Sacroiliac Fixation. Romeo N, Romeo NM. Clin Orthop Relat Res. 2020 Apr.

Technique for Open Reduction and Internal Fixation of Lateral Process Talus Fractures.

Romeo NM, Benirschke SK, Firoozabadi R, Romeo NM, et al. J Orthop Trauma. 2020 Feb.

Significance of Lateral Process Fractures Associated With Talar Neck and Body Fractures.

Romeo NM, Hirschfeld AG, Githens M, Benirschke SK, Firoozabadi R, Romeo NM, et al. J Orthop Trauma. 2018 Dec.

Incidence of Vacuum Phenomenon Related Intra-articular or Subfascial Gas Found on Computer-Assisted Tomography (CT) Scans of Closed Lower Extremity Fractures.

Noble T, Romeo NM, LeBrun CT, DiPasquale T, Noble T, et al. J Orthop Trauma. 2017 Nov.

Interprosthetic Fractures of the Femur. Romeo NM, Firoozabadi R, Romeo NM, et al. Orthopedics. 2018 Jan 1.

Compartment syndrome following use of tissue plasminogen activator for frostbite in the setting of concomitant diaphyseal tibia fracture. Joseph NM, Alfonso N, Hirschfeld AG, Joseph NM, et al. OTA Int. 2020 May 22.

Biomechanical Comparison of Fixed- versus Variable-Angle Locking Screws for Distal Humerus Comminuted Fractures. Nourbakhsh A, Hirschfeld AG, Dhulipala S, Hutton W, Ganey T, Lozada L, Schlatterer D, Lourie GM, Nourbakhsh A, et al. Clin Orthop Surg. 2019 Sep.

Significance of Lateral Process Fractures Associated With Talar Neck and Body Fractures.

Romeo NM, Hirschfeld AG, Githens M, Benirschke SK, Firoozabadi R, Romeo NM, et al. J Orthop Trauma. 2018 Dec.

Virtual Reality Tools for Assessing Unilateral Spatial Neglect: A Novel Opportunity for Data Collection.

Schwab PJ, Miller A, Raphail AM, Levine A, Haslam C, Coslett HB, Hamilton RH. Schwab PJ, et al. J Vis Exp. 2021 Mar 10.

Open Reduction Is Associated With Greater Hazard of Early Reoperation After Internal Fixation of Displaced Femoral Neck Fractures in Adults 18-65 Years.

Patterson JT, Ishii K, Tornetta P 3rd, Leighton RK, Friess DM, Jones CB, Levine A, Maclean JJ, Miclau T 3rd, Mullis BH, Obremskey WT, Ostrum RF, Reid JS, Ruder JA, Saleh A, Schmidt AH, Teague DC, Tsismenakis A, Westberg JR, Morshed S .Patterson JT, et al. J Orthop Trauma. 2020 Jun.

Acute Rupture of Achilles Tendon in an Adolescent with a History of Ponseti Casting and Achilles Tenotomy: A Case Report. Egger AC, Levine AD, Mistovich RJ, Egger AC, et al. JBJS Case Connect. 2019 Apr-Jun.