|The 2016 AAOS/OTA/SOMOS/ORS Extremity War Injuries (EWI) Symposium was held in Washington DC on January 18-20, 2016. For 11 years the EWI symposium has brought the military and civilian orthopaedic trauma communities together to share best practices and define research priorities for the future. This year’s theme was: “Maintaining Force Readiness During an Era of Military Transition.” The METRC Bioburden Team led by Dr. Michael Bosse won this year’s Best Poster Award (link to poster). METRC investigators also presented preliminary results from the Trauma Collaborative Care Study (link to abstract). For the complete agenda for EWI XI, click here.|
The Major Extremity Trauma Research Consortium (METRC) was established in September of 2009 with funding from the Department of Defense (DOD). It consists of a network of clinical centers and one data-coordinating center that works together with the DOD to conduct multi-center clinical research studies relevant to the treatment and outcomes of orthopaedic trauma sustained in the military. The overall goal of the Consortium 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 to the extremities.
CORE AREAS OF RESEARCH
METRC will initially focus its efforts on research relevant to the early, acute treatment of major limb trauma. Over time, the Consortium will leverage its infrastructure to address other priority topics of relevance to both the acute care and rehabilitation of the wounded warrior and civilian trauma patient.
Priorities for investigation will be established in six core areas:
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.
Read more about the BIOBURDEN study here.
This study will compare two standard options for treating severe open tibia fractures: internal fixation with a nail or plate and external ring fixation.
Read more about the FIXIT study here.
METALS II Study
This study will provide a comprehensive longitudinal assessment of the clinical, functional and mental health consequences of major limb trauma and add to our understanding of the long-term benefits of reconstruction vs. amputation for the most severely injured. Importantly, we will be able to examine potential differences in care and outcomes for those injured earlier and later in OIF/OEF/OND to identify changes in care that may have influenced service use and outcomes.
Read more about the METALS II study here.
This study will collect information about the treatment of peripheral nerve injury (PNI) resulting from upper extremity trauma.
Read more about the NERVE study here.
The purpose of this study is to compare 18 month functional outcomes and health related quality of life (HRQoL) of patients undergoing salvage versus amputation following severe distal tibia, ankle and/or foot injuries with major soft tissue, bone and/ or ankle articular surface loss.
Read more about the OUTLET study here.
This study will assess the efficacy of supplemental perioperative oxygen in the prevention of surgical site infections.
Read more about the Oxygen study here.
The long-term objective of this research is to develop a tool that can aid clinicians in making a timely and accurate diagnosis of acute compartment syndrome (ACS) so that early fasciotomy can be done and unnecessary fasciotomy avoided.
Read more about the PACS study here.
The objective of this study is to compare the efficacy of standard pain management vs. standard pain management combined with use of perioperative pregabalin (Lyrica) or ketorolac (Toradol) in the treatment of severe lower limb fractures.
Read more about the PAIN study here.
The goal of this study is to investigate the efficacy of oral (par oris - PO) antibiotic therapy versus intravenous (IV) systemic antibiotics in the treatment of acute infection after plate fixation of fractures.
Read more about the POvIV study here.
The primary objective of this study is to examine the benefits (and cost-benefits) of an integrated orthotic and rehabilitation program that incorporates the Intrepid Dynamic Exoskeletal Orthosis (IDEO) and the Return to Run (RTR) physical therapy regimen, but designed for scalability in the broader military environment.
Read more about the PRIORITI-MTF study here.
Recruitment website: www.prioriti-mtf.org.
The aims of this study address an exploratory endpoint in the Transtibial Amputation Outcomes Study (TAOS), which will investigate prosthesis fit, alignment and condition of the residual limb.
Read more about the ProFit study here.
The purpose of this study is to determine if rhBMP-2, a bone graft substitute, is as effective as using bone from the hip (iliac crest autograft) to help promote healing of open, tibia fractures with a bone defect.
Read more about the pTOG study here.
The purpose of this study is to test the effectiveness of the REPAIR intervention (physical therapy (PT) plus blood flow restricted (BFR) training) when compared to usual care PT alone.
Read more about the REPAIR study here.
This study will examine the reliability, validity and responsiveness of the PROMIS tools for clinical research following orthopaedic trauma.
Read more about the STREAM study here.
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).
Read more about the TAOS study here.
This study will evaluate the effectiveness of Trauma Collaborative Care (TCC) in improving outcomes for patients with severe orthopaedic trauma.
Read more about the TCC study here.
The primary objective of this study is to compare the proportion of deep surgical site infections within 6 months in patients treated with local Vancomycin powders compared to those treated without local Vancomycin powder.
Read more about the Vanco study here.
METRC Clinical Sites
METRC is a collaboration of 22 Core Civilian Trauma Centers, 4 Military Treatment Facilities, and 30 Satellite Centers throughout the United States, unified to identify and address critical issues challenging the recovery of combat and civilian trauma patients.