Heather Vallier

• Case Western Rserve

Introduction The purpose of this study was to evaluate surgeons' ability to perform or supervise a standard operation with agreed-upon radiologic parameters after being on call. Methods We reviewed a consecutive series of patients with intertrochanteric hip fractures treated with a fixed angle device at 9 centers and compared corrected tip-apex di...

Purpose: A notable percentage of people that die by suicide have had a medical visit within a few months of their death. In a survey-based experiment, we evaluated: 1) whether there are any surgeon, setting, or patient factors associated with surgeon rating of mental health care opportunities, and 2) if there are any surgeon, setting, or patient f...

Objectives: The purpose of this study was to identify the patient, injury, and treatment factors associated with infection of bicondylar plateau fractures and to evaluate whether center variation exists. Design: Retrospective review. Setting: Eighteen academic trauma centers. Patients/participants: A total of 1,287 patients with 1,297 OTA ty...

The purpose of this multicenter retrospective chart review was to describe demographics, fracture and wound characteristics, and treatments for foot and/or ankle fractures caused by gunshot wounds (GSWs) and identify factors that increase risk of infection in adults treated at five urban level 1 trauma centers in South and Midwest regions of the Un...

Category Ankle; Ankle Arthritis; Trauma Introduction/Purpose Ankle fractures are among the most commonly surgically treated orthopaedic injuries, with debate regarding their long-term outcomes and the clinical benefit of contemporary fixation strategies. The purpose of this study was to retrospectively evaluate the functional outcomes of patients...

Objective: To identify the patient, injury and treatment factors associated with an acute infection during the treatment of open ankle fractures in a large multi-center retrospective review. To evaluate the effect of infectious complications on the rates of nonunion, malunion, and loss of reduction. Design: Multi-center Retrospective Review. Se...

Objectives: To report functional outcomes of unilateral sacral fractures treated both operatively and nonoperatively. Design: Prospective, multicenter, observational. Setting: 16 level 1 trauma centersPatients/participants: Skeletally mature patients with unilateral zone 1 or 2 sacral fractures categorized as: displaced nonoperative (DN), disp...

Objectives: We conducted a large, U.S wide, observational study of type III tibial fractures, with the hypothesis that delays between definitive fixation and flap coverage might be a substantial modifiable risk factor associated with nosocomial wound infection. Design: A retrospective analysis of a multicenter database of open tibial fractures r...

Background Systems-based practice is a core competency of orthopaedic residency, yet there is no defined curriculum to address this area, which may leave residents with gaps in knowledge. Objective The aim of this study was to assess residents’ understanding of systems-based practice and interest in incorporating these principles into curricula....

Introduction: Ankle fractures are one of the most prevalent musculoskeletal injuries, with a significant number requiring surgical treatment. Postoperative complications requiring additional interventions frequently occur during the early postoperative period. We hypothesize that there is a limited need for routine clinical and radiographic follow...

Objectives: To evaluate a large series of open fractures of the forearm after gunshot wounds (GSWs) to determine complication rates and factors that may lead to infection, nonunion, or compartment syndrome. Design: Multicenter retrospective review. Setting: Nine Level 1 Trauma Centers. Patients/participants: One hundred sixty-eight patients...

Objectives: To review a large, multicenter experience to identify the current salvage and amputation rates of these combined injuries and where possible, the variables that predict amputation. Design: Retrospective. Setting: Nice trauma centers. Patients: 199 patients presenting to 9 trauma centers with orthopaedic and vascular injuries resu...

Importance Numerous studies have demonstrated that long-term outcomes after orthopedic trauma are associated with psychosocial and behavioral health factors evident early in the patient’s recovery. Little is known about how to identify clinically actionable subgroups within this population. Objectives To examine whether risk and protective factors...

Introduction: Extremity involvement is common among nonfatal gunshot injuries. Most of these injuries are low energy in nature and may be associated with fractures. Although displaced fractures of lower extremity long bones are often treated surgically, the purpose of this study was to review our experience in managing incomplete femur fractures c...

Objective: The purpose of this study was to determine which factors influence inpatient and postdischarge opioid use after orthopaedic trauma. Design: Retrospective cohort study. Setting: Single Level 1 trauma center. Participants: The study included 235 adult trauma patients treated operatively for fracture with minimum 1 overnight hospital...

Objectives: What are the differences between elective and trauma patient satisfaction and do patient and diagnosis factors predict physician scores? Design: Prospective cohort study SETTING:: Urban Level 1 Trauma center PATIENTS/PARTICIPANTS:: 323 trauma patients and 433 elective orthopaedic patients treated at our center by the same surgeons IN...

* Patients with multiple-system trauma are best managed by a multidisciplinary team. * The general trauma surgeon is the leader of the care team, facilitating expeditious evaluation, resuscitation, and other treatment. * Early Appropriate Care is the definitive treatment of mechanically unstable fractures of the thoracolumbar spine, pelvis, acetabu...

The injury parameters and patient characteristics that affect function after scapular fracture are poorly defined. We performed a retrospective review of 594 adult patients with a minimum 12-month follow-up after scapular fracture. Functional outcomes were prospectively assessed using the American Shoulder and Elbow Surgeons (ASES) survey in 153 pa...

This study evaluated patients with displaced clavicle fractures treated surgically vs nonoperatively. The authors hypothesized that functional outcomes would be no different. A retrospective comparative study was performed of 138 patients with closed midshaft clavicle fractures. Sixty-nine patients were treated operatively and matched for sex, age,...

Background: The purpose of this project was to compare the rates of infections, nonunions, malunions, and secondary operations in tibia fractures resultant from low energy GSWs versus those seen in open and closed tibia fractures resultant from blunt trauma. A secondary objective was to assess the utility of using the traditional Gustilo-Anderson...

Objective: To characterize the charges and collections associated with the initial inpatient management of trauma patients who undergo operative fracture management DESIGN:: Retrospective SETTING:: Level 1 trauma center PARTICIPANTS:: 440 consecutive adult trauma patients INTERVENTION:: fixation for fracture of the spine, pelvis, acetabulum, and/o...

The purpose of this study was to determine current practice patterns in the treatment of low energy gunshot wounds involving bones and joints. One hundred seventy-three Orthopaedic Trauma Association (OTA) members completed a web-based survey. The survey included practices for antibiotic therapy and operative treatment for different types of low-en...

Study design: Retrospective case series. Objective: To characterize outcomes associated with tracheostomy timing following traumatic cervical spinal cord injury (CSCI). Summary of background data: The morbidity associated with cervical spine trauma is substantially increased in the setting of concomitant CSCI. Despite recent evidence, it remai...

Introduction The purpose of this study was to quantify how opioid use in patients with traumatic injury compared with opioid use in patients undergoing elective arthroplasty. Methods In a retrospective review, 235 adult trauma patients treated surgically for fracture were compared with 98 patients undergoing elective total hip or knee arthroplasty...

Objectives: To determine the incidence of hypovitaminosis D and to evaluate a supplementation intervention. We hypothesized that patients would exhibit high adherence with a free sample, and levels would become sufficient. Design: Prospective observational study. Setting: Level 1 trauma center. Patients: One hundred forty-four consecutive, s...

OBJECTIVE Few studies have investigated the advantages of early spinal stabilization in the patient with polytrauma in terms of reduction of morbidity and mortality. Previous analyses have shown that early stabilization may reduce ICU stay, with no effect on complication rates. METHODS The authors prospectively observed 340 polytrauma patients wit...

Daily administration of vitamin D is important for maintaining bone homeostasis. The orthopedic community has shown increased interest in vitamin D supplementation and patient outcomes after fracture. The current study used data from a large hip fracture trial to determine the proportion of patients who consistently used vitamin D after hip fractur...

Study design: Retrospective. Objective: The purpose of this project is to identify factors that predict vertebral artery injury (VAI) in an effort to assess risks and benefits of computed tomography angiography (CT-A) of the neck in the trauma setting. We seek to develop guidelines for practitioners to stratify patients at medium/high risk of VA...

Objectives: To evaluate the ability of measures of coagulopathy and acidosis to predict complications. We hypothesize that increased coagulopathy and acidosis over the first 60 hours of hospitalization will result in increased rates of infection and mortality. Design: Prospective, observational. Setting: Level 1 trauma center. Patients: Thre...

Objective: To review the efficacy of a treatment approach for patients with infection and colonized implants after open reduction and internal fixation of fractures. Design: Retrospective case series. Setting: Level one trauma center. Patients: Twenty patients were treated for wound infection with colonized implants after open reduction and...

Background Surgery for patients with gunshot wound spinal cord injury (GSCI) remains controversial. Few recent studies provide standardized follow-up and detailed functional outcomes. To our knowledge, the research we present in this study is unique in that we are the first to incorporate Functional Independence Measure (FIM) scores as an outcomes...

Background Context Previous studies have suggested pulmonary complications are common among patients undergoing fixation for traumatic spine fractures. This leads to prolonged hospital stay, worse functional outcomes, and increased economic burden. However, only limited prognostic information exists regarding which patients are at greatest risk for...

Poor pain control after orthopaedic trauma is a predictor of physical disability and numerous negative long-term outcomes. Despite increased awareness of the negative consequences of poorly controlled pain, analgesic therapy among hospitalized patients after orthopaedic trauma remains inconsistent and often inadequate. The Pain study is a 3 armed,...

Background: Pantalar dislocations without associated talar fracture are rare and have high risks of complications, including infection, osteonecrosis, and posttraumatic osteoarthrosis. Limited information on later function exists. This study evaluated complications and outcomes following pantalar dislocation without talar fracture. Methods: Nine...

Objectives: To describe clinical results and functional outcomes of knee dislocations treated with a consistent strategy within our institution. Design: Retrospective case series. Setting: Level 1 trauma center. Patients: One hundred nineteen patients were treated at one institution between 2000 and 2014 for knee dislocation. Main outcome m...

A number of clinical studies in the spine literature suggest that the use of local vancomycin powder may substantially reduce surgical site infections (SSIs). These studies are primarily retrospective and observational and few focus on orthopaedic trauma patients. This study is a phase III, prospective, randomized, clinical trial to assess the effi...

Objectives: The purpose of this study is to characterize the demographics, interventions, infection rates, and other complications following intra-articular gunshot wounds. Design: Retrospective review. Setting: Level I trauma center. Patients/participants: Fifty-three patients with 55 civilian low-velocity intra-articular gunshot injuries w...

Objectives: To determine the rates of infection in low-energy gunshot wounds (GSWs) to the extremity. Design: Retrospective review. Setting: Level I trauma center. Patients/participants: Patients (N=140) with at least 90-day follow-up for extremity-only low-energy GSW injuries from 2010-2014 were retrospectively reviewed. Treatment was recor...

Aims: The best time for definitive orthopaedic care is often unclear in patients with multiple injuries. The objective of this study was make a prospective assessment of the safety of our early appropriate care (EAC) strategy and to evaluate the potential benefit of additional laboratory data to determine readiness for surgery. Patients and metho...

Background: Periprosthetic distal femur (PPDF) fractures occur most frequently via low energy mechanisms in elderly patients. This population is often frail and ill-suited to the physiologic burden of trauma and surgery. Here, we describe the perioperative and early hospital course for patients with PPDF fractures, and identify risk factors for po...

Displaced distal tibia shaft fractures are effectively treated with standard plates and intramedullary nails. Plate fixation performed with meticulous soft tissue handling results in minimal risks of infection and poor wound healing. Standard plates have high rates of primary union, whereas locking plates may delay union because of increased stiffn...

Objectives: Controversy exists over association of blood transfusions with complications. The purpose was to assess effects of limited transfusions on complication rates and hospital course. Setting: level 1 trauma center PATIENTS AND METHODS:: 371 consecutive patients with ISS≥16 underwent fixation of fractures of spine (n = 111), pelvis (n = 7...

Background Previous work established resuscitation parameters that minimize complications with early fracture management. This Early Appropriate Care (EAC) protocol was applied to patients with advanced age to determine if they require unique parameters to mitigate complications. Methods Between October 2010 and March 2013, 376 consecutive skeleta...

Objectives: To compare single versus multiple procedures in the same surgical setting. We hypothesized that complication rates would not be different and length of stay would be shorter in patients undergoing multiple procedures. Design: Prospective, cohort. Setting: Level 1 trauma center. Patients/participants: A total of 370 patients with...

Objectives: Recent data has challenged the historical precedent of non-operative care for many clavicle fractures; clinical and biomechanical studies have shown altered joint-contact forces occur in the glenohumeral joint (GHJ) following fracture and shortening of the clavicle. However, to date, there have been no analyses documenting the long-ter...

Introduction: This study evaluated the effects that patient demographics, injury, and social characteristics have on functional outcomes after clavicle fracture. Methods: After a mean follow-up of 56 months, 214 patients with a mean age of 44.4 years completed the American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form....

Background The frequency of acetabular fractures in elderly patients is rising over time. The group presents with underlying challenges including osteoporosis, medical comorbidities, and varying levels of baseline physical and cognitive function. The purposes of this study were to characterize such patients and to determine rates of complications a...

Objectives: Lessons learned from battle have been fundamental to advancing the care of injuries that occur in civilian life. Equally important is the need to further refine these advances in civilian practice, so they are available during future conflicts. The Major Extremity Trauma Research Consortium (METRC) was established to address these need...

The goals of this study were to determine the frequency of trauma recidivism and to identify risk factors. The authors hypothesized that substance abuse and mental illness would be associated with recidivism. They performed a retrospective review of 879 patients who were treated surgically for high-energy fractures over a period of 4 years. Recidiv...

Clavicle fractures are common in adults. Recent studies have shown that operative treatment of clavicle fractures has benefits in many situations. However, there is controversy about the indications. Data on social outcomes are limited. A total of 434 patients with 436 clavicle fractures treated both operatively and nonoperatively at a level 1 trau...

BACKGROUND: Psychiatric disorders are common, and their functional consequences may be underappreciated by non-mental health-care providers. There exist limited data regarding the frequency of psychiatric illness in patients who sustain orthopaedic polytrauma. The purpose of this study was to describe the prevalence of psychiatric illness in patien...

Objectives: The purpose was to evaluate economic benefit of calcium and vitamin D supplementation in orthopaedic trauma patients. We hypothesized that reduced nonunion rates could justify the cost of supplementing every orthopaedic trauma patient. Design: Retrospective, economic model SETTING:: Level 1 trauma center PATIENTS/PARTICIPANTS:: Adult...

Background Knee dislocations are rare injuries with potentially devastating vascular complications. An expeditious and accurate diagnosis is necessary, as failing to diagnose vascular injury can result in amputation; however, the best diagnostic approach remains controversial. Questions/purposesWe asked: (1) What patient factors are predictors of v...

Objectives: We hypothesized that a standardized protocol for fracture care would enhance revenue by reducing complications and length of stay. Design: Prospective, consecutive series SETTING:: Level 1 trauma center PATIENTS/PARTICIPANTS:: 253 adult patients with mean age 40.7 and mean ISS 26.0 INTERVENTION:: Femur, pelvis, or spine fractures tre...

Introduction: Isolated fractures of the lower extremity are relatively common injuries while multifocal injuries resulting from high-energy trauma are less frequently encountered. Our objectives are to characterise patients who sustained multiple noncontiguous fractures and open fractures of the lower extremity, report the incidence of major compl...

Our group developed a protocol, entitled Early Appropriate Care (EAC), to determine timing of definitive fracture fixation based on presence and severity of metabolic acidosis. We hypothesized that utilization of EAC would result in fewer complications than a historical cohort and that EAC patients with definitive fixation within 36 h would have fe...

Study design: Retrospective review. Objective: The objective of this study was to evaluate the ability of the American Spinal Injury Association (ASIA) Impairment Scale and neurological level of injury to predict the need for mechanical ventilation as well as tracheostomy. Summary of background data: High-level cervical spinal cord injuries, h...

Optimal patterns for fluid management are controversial in the resuscitation of major trauma. Similarly, appropriate surgical timing is often unclear in orthopedic polytrauma. Early appropriate care (EAC) has recently been introduced as an objective model to determine readiness for surgery based on the resuscitation of metabolic acidosis. EAC is an...

Talus fractures occur rarely but are often associated with complications and functional limitations. Urgent reduction of associated dislocations is recommended with open reduction and internal fixation of displaced fractures when adjacent soft tissue injury permits. Delayed definitive fixation may reduce the risks of wound complications and infecti...

Bilateral femur fractures have been associated with frequent morbidity and mortality. Associated injuries and massive hemorrhage contributed to mortality rates that were as high as 27% in previous reports. The goals of this study were to determine the frequency of associated complications, including mortality, and to identify which patient and inju...

We developed a protocol to determine timing of definitive fracture care based on the adequacy of resuscitation. Inception of this project required a multidisciplinary group, including physicians from anesthesiology, general trauma and critical care, neurosurgery, orthopaedic spine and orthopaedic trauma. The purposes of this study were to review ou...

The objective of this study is to characterize relationships between obesity and initial hospital stay, including complications, in patients with multiple system trauma and surgically treated fractures. Prospective, observational. Level 1 trauma center. 376 patients with an Injury Severity Score (ISS) greater than 16 and mechanically unstable, high...

Objective: To characterize the timing, indications, and "success rates of secondary interventions, dynamization and exchange nailing, in a large series of tibial nonunions" (dynamization and exchange nailing are types of secondary interventions). Setting: Retrospective multicenter analysis from level 1 trauma hospitals. Patients: A total of 19...

Background: The early appropriate care (EAC) protocol and clinical grading system (CGS) propose criteria that suggest timing of definitive fracture fixation by assessing risk for complications. This study applies these criteria to a cohort of patients with orthopedic injuries and determines clinical outcomes for groups stratified by risk and timin...

Background: Femur fractures are common among trauma patients and are typically seen in patients with multiple injuries resulting from high-energy mechanisms. Internal fixation with intramedullary nailing is the ideal method of treatment; however, there is no consensus regarding the optimal timing for internal fixation. We critically evaluated the...

Changes in health care reimbursement will reward systems that can improve patient outcomes and reduce costs. We implemented an integrated-care pathway protocol that coordinates the efforts of all the teams involved in the care of multiple-trauma patients by providing standard resuscitation parameters to recommend timing of definitive fracture fixat...

Little data exist regarding the outcomes of total hip arthroplasty (THA) after acetabular fracture treatment failure. We hypothesize that these patients achieve a lower level of function than those who undergo primary total hip arthroplasty for osteoarthritis (atraumatic). Retrospective review. Control group consisted of sequential patients who und...

Our purpose was to compare patients transferred from another hospital to our trauma center with those arriving directly, in order to identify barriers to care of similar fractures. We hypothesized the most frequent reason for delayed definitive fixation would be inter-hospital transfer and that patients would be transferred primarily for two reason...

The purpose of the study was to review diagnostic imaging in trauma patients. We hypothesized that diagnostic musculoskeletal imaging has increased over time, but at a lesser rate than radiography performed for other purposes. Two trauma centers were compared. retrospective, multi-center SETTING:: Two level 1 trauma centers PATIENTS/PARTICIPANTS::...

Osteonecrosis and posttraumatic arthritis are common after talar neck fracture. We hypothesized that delay of definitive fixation would not increase the rate of osteonecrosis, but that the amount of initial fracture displacement, including subtalar and/or tibiotalar dislocations, would be predictive. We investigated the possibility of dividing the...

The purpose of this study is to characterize the presentation, size, treatment, and complications of pulmonary embolism (PE) in a large series of orthopaedic trauma patients who developed PE after injury. We reviewed the records of orthopaedic trauma patients who developed a PE within 6 months of injury at 9 trauma centers and 2 tertiary care facil...

OBJECTIVES:: The purpose was to define which clinical conditions warrant delay of definitive fixation for pelvis, femur, acetabulum, and spine fractures. A model was developed to predict complications. DESIGN:: Statistical modeling based on retrospective database SETTING:: Level 1 trauma center Patients/participants: 1443 adults with pelvis (n=291)...

Abdominal injury has been shown to be an independent risk factor for pulmonary complications in patients with extremity injuries. We propose to characterize orthopedic patients with severe abdominal trauma. We hypothesize that operative fractures of the thoracolumbar spine, pelvis, acetabulum, or femur increase systemic complications in patients wi...

Objectives: We hypothesized that early definitive management (within 24 hours of injury) of mechanically unstable fractures of the pelvis, acetabulum, femur and spine would reduce complications and shorten length of stay. Design: Retrospective review. Setting: Level 1 trauma center. Patients/participants: 1005 skeletally mature patients with...

This CORR Insights™ is a commentary on the article "Locking Buttons Increase Fatigue Life of Locking Plates in a Segmental Bone Defect Model" by Tompkins et al. available at DOI 10.1007/s11999-012-2664-1 .

Optimal timing of definitive treatment of femoral shaft fractures in patients with multiple injuries remains controversial. This study aimed to determine the impact of timing of definitive treatment (early, delayed, or damage-control orthopedics [DCO]) of femoral shaft fractures on the incidence of adult respiratory distress syndrome (ARDS), mortal...

Introduction: Osteocutaneous pedicle flap transfer from the foot can be used to "salvage" a transtibial amputation level when the severity of an injury precludes a transtibial amputation. Step 1 preoperative assessment: If the posterior tibial artery is not palpable, obtain an angiogram to determine the vascular supply distal to the traumatic zo...

Objectives: The purpose was to define charges and reimbursement in the management of pelvis and acetabulum fractures and to identify opportunities for revenue enhancement. Design: Retrospective review. Setting: Level 1 trauma center. Patients/participants: Four hundred sixty-five patients with 210 pelvic ring injuries and 285 acetabulum frac...

This study investigates the impact of injury severity, patient origin, and payer on charges and payments associated with treatment of femoral fractures at a Level I trauma center. We hypothesized that transfer patients and patients with minor injury would be underinsured, whereas reimbursement rate would be higher for patients with severe injury. M...

A conventional transtibial amputation may not be possible when the zone of injury involves the proximal part of the tibia, or in cases of massive tibial bone and/or soft-tissue loss. The purpose of this study was to examine the outcomes of salvage of a transtibial amputation level with a rotational osteocutaneous pedicle flap from the ipsilateral h...

Residual dysfunction after pelvic trauma has been previously described, but limited functional outcome data are available in the female population after high-energy pelvic ring injury. The purposes of this study were to determine functional outcomes and to characterize factors predictive of outcome. Prospective collection of functional outcomes dat...

Computed tomography (CT) scans have become imaging modalities of choice in trauma centers. The purposes of this study were to evaluate the trend of radiation exposure in acute trauma patients. Our hypothesis was that radiation dosage and charges would increase over time without change in patient acuity or outcome. Five hundred consecutive trauma pa...

Surgical treatment of displaced distal tibia fractures yields reliable results with either plate or nail fixation. Comparative studies suggest more malalignment and nonunions with nails. Some studies have reported knee pain after tibial nailing. However, plates may be associated with soft tissue complications, such as infections or wound-healing pr...

In the distal femur, locked plating is efficacious when coronal fractures preclude the use of a conventional fixed-angle device. However, minimal comparative data exist for supracondylar fracture patterns, which could be treated with other devices. The purpose of this study was to compare the 95-degree angled blade plate (ABP) versus the Locking Co...

Previous studies reported negative effects of pelvic trauma on genitourinary and reproductive function with frequent cesarean delivery. Risk factors for cesarean delivery have not been well defined. The purpose of this project was to evaluate outcomes of pregnancy after pelvic ring injury. We hypothesized that cesarean delivery would be more freque...

Previous studies have reported a negative effect of pelvic trauma on genitourinary and reproductive function of women. However, fracture pattern, injury severity, and final fracture alignment have not been well studied. The purpose of this project was to describe sexual function in women after pelvic ring injury. Cohort study: a prospective collect...

Malalignment has been frequently reported after intramedullary stabilization of distal tibia fractures. Nails have also been associated with knee pain in several studies. Historically, plate fixation has resulted in increased risks of infection and nonunion. Our purposes were to compare plate and nail stabilization for distal tibia shaft fractures...

We conducted a study to evaluate the functional outcomes of elderly patients after open reduction internal fixation of intra-articular distal humerus fractures. Retrospective clinical and radiographic evaluation. A Level I trauma and tertiary referral center. We identified 23 eligible patients aged older than 65 years from the center's orthopaedic...

Type and timing of treatment of femur fractures is controversial. Although reported as safe and effective in many reports, others have suggested that early definitive stabilization may cause complications, particularly in patients with chest and head injuries. Damage control orthopedics was proposed as an alternative in unstable patients. This stud...

Although the benefits of acute stabilization of long bone fractures are recognized, the role of early fixation of unstable pelvis and acetabular fractures is not well-defined. The purpose of this study was to review complications and hospital course of patients treated surgically for pelvis and acetabulum fractures. We hypothesized that early defin...

Proximal humerus fractures occur frequently, and treatment remains controversial. This study compares stiffness in axial loading for 3 methods of fixation (locking compression plate, standard (nonlocking) proximal humerus plate, and blade plate) in a 3-part proximal humerus fracture model. Twelve paired proximal humeri were obtained from embalmed h...

Trauma is a major public health issue. The management of seriously injured patients requires the integration of rescue and transport services, resuscitation and reconstructive care in dedicated centers with access to physical and vocational rehabilitation. The management of injury is exceedingly complex and expensive. We are entering a period of un...