Research During 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, Orthopaedic Surgery Department Garceau-Wray Lectureship; and submit a manuscript.

Ongoing research and grant funding at IU School of Medicine has led to employment of full-time research coordinators and research assistants allocated only to the orthopaedic trauma service. This improves the efficiency of the research projects and provides the fellows with 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 METRC investigations can be found at https://www.metrc.org/research/. Additionally, the department has many established national collaborations.

Fellow Publications

2016

Wetzel RJ, Kempton LB, Lee ES, Zlowodzki M, McKinley TO, Virkus WW. Wide Variation of Surgical Cost in the Treatment of Periarticular Lower Extremity Injuries Between 6 Fellowship-Trained Trauma Surgeons. J Orthop Trauma. 2016 Dec;30(12):e377-e383. doi: 10.1097/BOT.0000000000000687. PMID: 27870692. PubMed.
2018

Cavallero M, Rosales R, Caballero J, Virkus WW, Kempton LB, Gaski GE. Locking Plate Fixation in a Series of Bicondylar Tibial Plateau Fractures Raises Treatment Costs Without Clinical Benefit. J Orthop Trauma. 2018 Jul;32(7):333-337. doi: 10.1097/BOT.0000000000001188. PMID: 29738401. PubMed.

Virkus WW, Wetzel RJ, McKinley TO, Sorkin AT, Cheesman JS, Hill LC, Kempton LB. Costs and Radiographic Outcomes of Rotational Ankle Fractures Treated by Orthopaedic Surgeons With or Without Trauma Fellowship Training. J Am Acad Orthop Surg. 2018 Jun 15;26(12):e261-e268. doi: 10.5435/JAAOS-D-16-00687. PMID: 29787464. PubMed.

Virkus WW, Caballero J, Kempton LB, Cavallero M, Rosales R, Gaski GE. Costs and Complications of Single-Stage Fixation Versus 2-Stage Treatment of Select Bicondylar Tibial Plateau Fractures. J Orthop Trauma. 2018 Jul;32(7):327-332. doi: 10.1097/BOT.0000000000001167. PMID: 29920192. PubMed.
2019

Virkus WW, Wetzel RJ, McKinley TO, Sorkin AT, Cheeseman JS, Hill LC, Kempton LB. Response to Letter to the Editor: Costs and Radiographic Outcomes of Rotational Ankle Fractures Treated by Orthopaedic Surgeons With or Without Trauma Fellowship Training. J Am Acad Orthop Surg. 2019 Feb 1;27(3):e143-e145. doi: 10.5435/JAAOS-D-18-00509. PMID: 30320736. PubMed.
FAITH-2 Investigators, Slobogean GP, Sprague S, Bzovsky S, Heels-Ansdell D, Thabane L, Scott T, Bhandari M. Fixation using alternative implants for the treatment of hip fractures (FAITH-2): design and rationale for a pilot multi-centre 2 × 2 factorial randomized controlled trial in young femoral neck fracture patients. Pilot Feasibility Stud. 2019 May 28;5:70. doi: 10.1186/s40814-019-0458-x. PMID: 31161044; PMCID: PMC6540373. PubMed.

Natoli RM, Sardesai NR, Richard RD, Sorkin AT, Gaski GE, Virkus WW. Intramedullary Nailing of Lower-Extremity Periarticular Fractures. JBJS Essent Surg Tech. 2019 Nov 1;9(4):e35.1-2. doi: 10.2106/JBJS.ST.18.00112. PMID: 32051781; PMCID: PMC6974312. PubMed.
2020

Jang Y, Gaski G, Natoli R, Virkus W, Mckinley T. Tibial Fracture Healing Score: A Novel Tool to Predict Tibial Nonunion. Orthopedics. 2020 Jul 1;43(4):e323-e328. doi: 10.3928/01477447-20200521-07. Epub 2020 Jun 5. PMID: 32501520. PubMed.
Richard RD, Natoli RM, Sorkin AT, Virkus WW, Gaski GE. Retrograde intramedullary nailing below a hip arthroplasty prosthesis: a viable fixation option for periprosthetic and interprosthetic femur fractures. Int Orthop. 2020 Nov;44(11):2283-2289. doi: 10.1007/s00264-020-04734-3. Epub 2020 Jul 21. PMID: 32696332. PubMed.
2021

Lieder CM, Gaski GE, Virkus WW, Kempton LB. Is Immediate Weight-Bearing Safe After Single Implant Fixation of Elderly Distal Femur Fractures? J Orthop Trauma. 2021 Jan 1;35(1):49-55. doi: 10.1097/BOT.0000000000001882. PMID: 32639392. PubMed.

Slobogean GP, Sprague S, Bzovsky S, Scott T, Thabane L, Heels-Ansdell D, O'Toole RV, Howe A, Gaski GE, Hill LC, Brown KM, Viskontas D, Zomar M, Della Rocca GJ, O'Hara NN, Bhandari M; FAITH-2 Investigators. Fixation using Alternative Implants for the Treatment of Hip Fractures (FAITH-2): The Exploratory Health-Related Quality of Life and Patient-Reported Functional Outcomes of a Multi-Centre 2 × 2 Factorial Randomized Controlled Pilot Trial in Young Femoral Neck Fracture Patients. Injury. 2021 Feb 14:S0020-1383(21)00133-9. doi: 10.1016/j.injury.2021.02.030. Epub ahead of print. PMID: 33618847. PubMed.

Jang Y, Virkus W, Mckinley T. A modified Levine approach for exposure of the anterior column, anterior wall and sacroiliac joint: a surgical technique and a case series. J Orthop Trauma. 2021 Mar 9. doi: 10.1097/BOT.0000000000002111. Epub ahead of print. PMID: 33724966. PubMed.

Sardesai NR, Gaski GE, Gunderson ZJ, Cunningham CM, Slaven J, Meagher AD, McKinley TO, Natoli RM. Polytraumatized patient lower extremity nonunion development: Raw data. Data Brief. 2021 Jun 25;37:107244. doi: 10.1016/j.dib.2021.107244. PMID: 34258338; PMCID: PMC8253899. PubMed.

Sardesai NR, Gaski GE, Gunderson ZJ, Cunningham CM, Slaven J, Meagher AD, McKinley TO, Natoli RM. Polytraumatized patient lower extremity nonunion development: Raw data. Data Brief. 2021 Jun 25;37:107244. doi: 10.1016/j.dib.2021.107244. PMID: 34258338; PMCID: PMC8253899. PubMed.

Ongoing Clinical Studies

PRECISE

To evaluate the use of precision methods that quantify injury and response to injury to predict how short-term clinical outcomes are affected by initial and staged orthopaedic interventions in multiple injured patients who sustain major orthopaedic trauma.
WINDOWS

Precision medicine approach based on discrete time windows for predicting outcomes of polytrauma patients. The overarching goal of this project is to deliver precision medicine tools that will predict each patient’s risk for adverse outcomes using patient-specific metrics that quantify genetic and demographic signatures combined with individualized injury and injury response signals to accurately stratify expected clinical trajectories.
Nonunions

Multiple projects evaluating various aspects of nonunions. Are all nonunions infected? Do nonunions need to be cultured? Can we predict nonunion early after fracture via biomarker signals obtained through serial sampling of peripheral blood? We also work with a consortium developing a large nonunion database allowing more questions to be asked by virtue of being less limited by sample size.
Amobarbital

Phase I/II clinical trial investigating the use of Amobarbital in mitigating PTOA development after pilon fractures.

Porcine Model of Composite Limb Trauma

Controlled segmental bone defects and volumetric muscle loss injuries are created in pig tibias. Bone healing and functional muscle tests, serum investigation of the immunologic response to trauma, and local tissue analyses of healing are performed to better understand muscle-bone interactions and potential treatments for these difficult to manage orthopaedic injuries.

Faculty Publications

Roman M. Natoli, MD, PhD

Dr. Natoli focuses on translational research to lessen the burden of post-traumatic problems.

PubMed
Walter W. Virkus, MD

Dr. Virkus has a diverse practice that includes orthopedic trauma, orthopedic oncology and hip reconstruction, He has a strong focus in treating nonunions, orthopedic infections and hip osteotomies. He also specializes in using oncological techniques for trauma reconstructions and using trauma techniques for oncologic reconstructions.
PubMed
Anthony T. Sorkin, MD

Dr. Sorkin’s practice is focused on orthopaedic trauma, including pelvis and limb reconstruction. He is active in continuing medical education and has spoken at numerous national and international meetings.
PubMed
Todd O. McKinley, MD

Dr. McKinley has been the principal investigator on six peer-reviewed grants, including three major grants from the Centers for Disease Control and Prevention, National Institutes of Health and the Department of Defense. He was appointed chairman of the Orthopaedic Trauma Association Research Committee and is a member of the Orthopaedic Research Society.
PubMed
Brian H. Mullis, MD

Dr. Mullis is the principal investigator in the multicenter allogeneic transfusion study which has received national attention for his innovative approach to reduced blood transfusions in trauma patients.
PubMed