Orthopaedic Surgery

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Research During Fellowship

Research Fellowship

Each fellow is required to complete one research project from idea inception to manuscript submission.

A structured research curriculum with associated timeline and dedicated meetings built into the academic calendar ensures success. Fellows work with the program director and faculty mentors to: develop a scientific question; generate a hypothesis; write a protocol to be approved by the Internal Review Board; perform data collection and analysis; submit an abstract to a national meeting; present the project at the year-end fellow/resident graduation; and submit a manuscript.

Ongoing research and grant funding at IU School of Medicine has led to employment of four full-time research coordinators and two research assistants allocated only to the orthopaedic trauma service. This improves the efficiency of the research projects and provides the fellows with ample administrative support to complete projects in a timely fashion.

As the director of the research program, Dr. Todd McKinley has been successful in securing over $10 million in grant funding to support the program.

Indiana University Health Methodist Hospital is an active member of METRC, the Major Extremity Trauma and Rehabilitation Consortium, serving as one of six ‘anchor’ sites. A list of ongoing and previous investigations through METRC is provided below.

The department has many established national collaborations with the following institutions: University of Pittsburgh Medical Center, University of Iowa, Uniformed Services University, University of Aachen, Germany, United States Army Institute of Surgical Research, McMaster University, University of Maryland / Shock Trauma Center.

Clinical Research

Natoli RM, Baer MR, Bednar MS. Conversion of external fixation to open reduction and internal fixation for complex distal radius fractures. Orthop Traumatol Surg Res. 2016 May;102(3):339-43

Borror W, Gaski GE, Steenburg S. Abdominopelvic bleed rate on admission CT correlates with mortality and transfusion needs in the setting of blunt pelvic fractures: a single institution pilot study. Emerg Radiol. 2018; Sep 26. [Epub ahead of print]

Hagen JE, Castillo R, Dubina A, Gaski GE, Manson TT, O’Toole RV. Does surgical stabilization of lateral compression-type pelvic ring fractures decrease patients’ pain, reduce narcotic use, and improve mobilization? Clin Orthop Rel Res. 2016 Jun;474(6):1422-1429.

Gaski GE, Manson TT, Castillo RC, Slobogean MG, O’Toole RV. Nonoperative treatment of intermediate severity lateral compression type 1 pelvic ring injuries with minimally displaced complete sacral fracture. Journal of Orthopaedic Trauma. 2014 Dec;28(12):674-680.

Natoli RM, Fogel HA, Hold D, Schiff A, Bernstein M, Summers HD, Lack W. Advanced Imaging Lacks Clinical Utility in Treating Geriatric Pelvic Tring Injuries cause by Low-energy Trauma. J Orthop Trauma. Apr 2017;31(4):194-199.

Nystrom LM, McKinley TO, Marsh JL. Radiographic Measurement of Rotational Deformity in Pelvic Fractures: A Novel Method With Validity and Reliability Testing. J Orthop Trauma. 365-369

Virkus WW, Kempton LB, Sorkin AT, Gaski GE. Intramedullary nailing of periarticular fractures. J Am Acad Orthop Surg. 2018;26(18):629-639.

McKinley TO, D’Alleyrand JCC, Valerio I, Schoebel S, Tetsworth K, Elster EA. Management of Mangled Extremities and Orthopaedic War Injuries. J Orthop Trauma. 2018 Mar; 32 Suppl:S1-S6.

Cavallero M, Rosales R, Caballero J, Kempton L, Virkus WW, Gaski GE. Locking Plate Fixation in a Series of Bicondylar Tibial Plateau Fractures Raises Treatment Costs Without Clinical Benefit. J Orthop Trauma. 2018;32(7):333:337

Virkus WW, Caballero J, Kempton LB, Cavallero M, Rosales R, Gaski GE. Costs and complications of single stage fixation versus two-stage treatment of select bicondylar tibial plateau fractures. J Orthop Trauma. 2018;32(7):327-332.

Bosse MJ, Teague D, Reider L, Gary JL, Morshed S, Seymour RB, Toledano J, Cannada LK, Steverson B, Scharstein DO, Luly J, MacKenzie EJ, and METRC. Outcomes after severe distal tibia, ankle, and/or foot trauma: Comparison of limb salvage versus transtibial amputation (OUTLET). J Orthop Trauma 2017;31:S48-S55.

O’Toole RV, Gary JL, Reider L, Bosse MJ, Gordon WT, Hutson J, Quinnan SM, Castillo RC, Scharfstein DO, MacKenzie EJ, and METRC. A prospective randomized trial to assess fixation strategies for severe open tibia fractures: Modern ring external fixators versus internal fixation (FIXIT Study). J Orthop Trauma 2017;31:S10-S17.

Jang Y, Kempton LB, McKinley TO, Sorkin AT. Insertion-related pain with intramedullary nailing. Injury. 2017 Jun;48 Suppl 1:S18-S21.

Dibbern K, Kempton LB, Higgins TF, Morshed S, McKinley TO, Marsh JL, Anderson DD. Fractures of the Tibial Plateau Involve Similar Energies as the Tibial Pilon but Greater Articular Surface Involvement. J Orthop Res. Mar;35(3):618-624

Natoli RM, Nypaver CM, Schiff AP, Hopkinson WJ, Rees HW. Total Knee Arthroplasty in Patients with Blount Disease or Blount-Like Deformity. J Arthroplasty. 2016 Jan;31(1):124-7.

Lieder C, Hellman M, Haughom B, Szatkowski J. Mid to distal third tibial shaft fractures caused by gunshots: Characterization and incidence of distal intra-articular extension. Injury. 2016;47(10):2347-2351.

Gaski GE, Wessel R, Metzger C, McCarroll T, Adler J, Cutshall A, Brown K, Vodovotz Y, Billiar T, McKinley TO. The Early Immunologic Response in Multiply Injured Patients with Orthopaedic Injuries is Associated with Organ Dysfunction. J Orthop Trauma. May 2019.

McKinley TO, Gaski GE, Lisboa FA, Horan AD, Mehta S. Precision medicine applications to manage multiply injured patients with orthopaedic trauma. J Orthop Trauma 2019. Accepted for publication.

McKinley TO, McCarroll T, Metzger C, Zarzaur BL, Savage SA, Bell TM, Gaski GE. Shock Volume: Patient-Specific Cumulative Hypoperfusion Predicts Organ Dysfunction in a Prospective Cohort of Multiply Injured Patients. J Trauma Acute Care Surg. 2018;85(1S Suppl 2):S84-S91.

McKinley TO, Gaski GE, Vodovotz Y, Corona BT, Billiar TR. Diagnosis and management of polytraumatized patients with severe extremity trauma. J Orthop Trauma. 2018;32 (Suppl 1):S1-S6.

Frantz TL, Steenburg SD, Gaski GE, Zarzaur BL, Bell TM, McCarroll T, McKinley TO. Tissue damage volume predicts organ dysfunction and inflammation after injury. J Surg Res 2016;202(1):188-95

Gaski GE, Frantz TL, Bell TM, Steenburg SD, McKinley TO. Large magnitude pelvic and retroperitoneal tissue damage predicts organ failure. Clin Orthop Rel Res 2016;474(6):1410-16

McKinley TO, McCarroll T, Gaski GE, Frantz TL, Zarzaur BL, Terry C, Steenburg SD. Shock volume: A patient-specific index that predicts transfusion requirements and organ dysfunction in multiply injured patients. Shock 2016;45(2):126-32

Frantz TL, Gaski GE, Terry C, Steenburg SD, Zarzaur BL, McKinley TO. The effect of pH versus base deficit on organ failure in trauma patients. J Surg Res 2016;200(1):260-65.

Wetzel RJ, Kempton LB, Lee ES, Zlowodzki M, McKinley TO, Virkus WW. Wide Variation of Surgical Cost in the Treatment of Peri-articular Lower Extremity Injuries between Six Fellowship-trained Trauma Surgeons.J Orthop Trauma. 2016 Dec;30(12):e377-e383

Virkus WW, Wetzel R, McKinley TO, Sorkin AT, Cheesman S, Hill L, Kempton LB. Costs and Radiographic Outcomes of Rotational Ankle Fractures Treated by Surgeons With or Without Trauma Fellowship Training. J Am Acad Orthop Surg. 2018;26(12):e261-e268.

Castillo RC, Huang Y, Scharfstein D, Frey K, Bosse MJ, Pollak AN, Vallier HA, Archer KR, Hymes RA, Newcomb AB, MacKenzie EJ, Wegener M, and METRC. Asociation between 6-week postdischarge risk classification and 12-month outcomes after orthopaedic trauma. JAMA Surg. 2018; Dec 19:e184824 [Epub ahead of print]

Hardeski D, Gaski GE, Joshi M, Venezia R, Nascone JW, Sciadini MF, O’Toole RV. Can applied external fixators be sterilized for surgery? A prospective cohort study of orthopaedic trauma patients. Injury 2016;47(12):2679-82

Major Extremity Trauma Research Consortium (METRC). Building a clinical research network in trauma orthopaedics: The Major Extremity Trauma Research Consortium (METRC). J Orthop Trauma 2016;30(7):353-61

Wegener ST, Carroll EA, Gary JL, McKinley TO, O’Toole RV, Sietsema DL, Castillo RC, Frey KP, Scharfstein DO, Huang Y, Collins SCJ, MacKenzie EJ; Major Extremity Trauma Research Consortium (METRC). Trauma Collaborative Care Intervention: Effect on Surgeon Confidence in Managing Psychosocial Complications after Orthopaedic Trauma. J Orthop Trauma. 2017 Aug; 31(8):427-433.

Zura R, Xiong Z, Einhorn T, Watson JT, Ostrum RF, Prayson MJ, Della Rocca GJ, Mehta S, McKinley T,Wang Z, Steen RG. Epidemiology of Fracture Nonunion in 18 Human Bones. JAMA Surg. 2016;151(11):e162775.

Ongoing Clinical Studies

METRC 3 Prospective observational study to determine how patient specific injury and response to injury affects outcomes after major orthopaedic surgical interventions. This investigation is a multicenter trial that is examining the physiologic and immunologic response to injury (through serial blood draws and cytokine/chemokine analyses) and staged fracture surgery. Greg Gaski, Site PI and Todd McKinley, Overall Study PI.

PCORI funded METRC randomized controlled trial comparing low molecular weight heparin (Lovenox) to aspirin for DVT prophylaxis. Greg Gaski, Site PI.

Randomized controlled trial comparing outcomes in patients with postoperative anemia treated with restrictive vs. liberal blood transfusion. Walter Virkus, Site PI. Brian Mullis, Overall Study PI.

METRC 2 RCT comparing the effects of oxygen restriction physical therapy on outcomes in patients sustaining closed femoral shaft fractures. Todd McKinley, Site PI.

Basic and Translational Science

Coleman MC, Goetz JE, Brouillette MJ, Seol D, Willey MC, Petersen EB, Anderson HD, Hendrickson NR, Compton J, Khorsand B, Morris AS, Salem AK, Fredericks DC, McKinley TO, Martin JA. Targeting mitochondrial responses to intra-articular fracture to prevent posttraumatic osteoarthritis. Sci Trasnl Med 2018 Feb 7;10(427).

Childress P, Brinker A, Gong CS, Harris J, Olivos DJ 3rd, Rytlewski JD, Scofield DC, Choi SY, ShiraziFrar Y, McKinley TO, Chu TG, Conley CL, Chakraborty N, Hammameih R, Kacena MA. Forces associated with launch into space do not impact bone fracture healing. Life Sci Space Res (Amst). 2018 Feb;16:52-62.

Natoli RM, Yu H, Meislin MC, Abbasnia P, Roper P, Vuchkovska A, Xiao X, Stock SR, Callaci JJ. Alcohol exposure decreases osteopontin expression during fracture healing and osteopontin-mediated mesenchymal stem cell migration in vitro. J Orthop Surg Res. 2018 Apr 27;13(1).

Hurtgen BJ, Ward CL, Leopold Wager CM, Garg K, Goldman SM, Henderson BEP, McKinley TO, Greising SM, Wenke JC, Corona BT. Autologous Minced Muscle Grafts Improve Endogenous Fracture Healing and Muscle Strength after Musculoskeletal Trauma. Physiol Rep. 2017 Jul; 5(14).

Hurtgen BJ, Henderson BEP, Ward CL, Goldman SM, Garg K, McKinley TO, Greising SM, Wenke JC, Corona BT. Impairment of early fracture healing by skeletal muscle trauma is restored by FK506. BMC Musculoskeletal Disord. 2017 Jun 12; 18(1):253.

Salazar TE, Richardson MR, Beli E, Ripsch MS, Georg J, Kim Y, Duan Y, Moldovan L, Yan Y, Bhatwadekar A, Jadhav V, Smith JA, McGorray S, Bertone AL, Traktuev DO, March KL, Colon-Perez LM, Avin KG, Sims E, Mund JA, Case J, Deng X, Kim MS, McDavitt B, Boulton ME, Thinschmidt J, Li Calzi S, Fitz SD, Fuchs RK, Warden SJ, McKinley TO, Shekhar A, Febo M, Johnson PL, Chang LJ, Gao Z, Kolonin MG, Lai S, Ma J, Dong X, White FA, Xie H, Yoder MC, Grant MB. Electroacupuncture Promotes Central Nervous System-Dependent Release of Mesenchymal Stem Cells. Stem Cells 2017 May;35(5):1303-1315.

Goetz JE, Coleman MC, Fredericks DC, Petersen E, Martin JA, McKinley TO, Tochigi Y. Time-dependent loss of mitochondrial function precedes progressive histologic cartilage degeneration in a rabbit meniscal destabilization model. J Orthop Res. Mar;35(3):590-599

Jewell E, Rytlewski J, Anglen JO, McKinley TO, Shively KD, Chu T-MG, Kacena MA‡. Surgical Fixation Hardware for Regeneration of Long Bone Segmental Defects: Translating Large Animal Model and Human Experiences. Clin Rev Bone Minerl Metab, 13:222-231

Griffin KS, Davis KM, McKinley TO, Anglen JO, Chu T-MG, Boerckel JD, Kacena MA. Evolution of bone grafting: Bone grafts and tissue engineering strategies for vascularized bone regeneration. Clin Rev Bone Miner Metab, 13:232-244

Hurtgen BJ, Ward CL, Garg K, Pollot BE, Goldman SM, McKinley TO, Wenke JC, Corona BT. Severe muscle trauma triggers heightened and prolonged local musculoskeletal inflammation and impairs adjacent tibia fracture healing. J Musculoskelet Neuronal Interact. 2016 Jun1;16(2):122-34.

Roper PM, Abbasnia P, Vuchkovska A, Natoli RM, Callaci JJ. Alcohol-related deficient fracture healing is associated with activation of FoxO transcription factors in mice. J Orthop Res. 2016;34(12):2106-2115.

Davis KM, Griffin KS, Chu T-MG, Wenke JC, Corona BT, McKinley TO, Kacena MA. Muscle-bone interactions during fracture healing. J Musculoskelet Neuronal Interact, 15:1-9, 2015