Our Research

To date, our team has completed more than 50 investigator-driven research studies.

We have explored:

  • Enhancing patient and surgical outcomes post-injury through diverse research approaches, including basic science, translational, and clinical research

  • Advanced imaging techniques (dynamic CT, micro-CT, weight-bearing CT), for injury assessment evaluation of novel surgical techniques, and assessment of fracture healing

  • Collaborative care for both victims and perpetrators of intimate partner violence

  • Prevention of post-injury complications, such as venous thromboembolism (blood clots)

PRECISION MEDICINE

“After my femur fracture, I was afraid to go to sleep because I worried that the blood clot in my leg would travel to my lung again, but this time, I may not wake up.”
— Patient Partner

  • Trauma-induced coagulopathy affects all patients with an injury, resulting in an immediate risk of bleeding, followed by a prolonged risk for blood clots, called venous thromboembolism (VTE)

  • VTE are devastating for patients, their families, and their surgeons

  • Blood clots in the legs, called deep vein thrombosis (DVT) can lead to debilitating pain and prolonged recovery from injury

  • Life-threatening pulmonary embolism (PE) is a significant cause of preventable death in trauma patients

  • Major orthopaedic fracture is an independent risk factor for VTE

  • 7-fold increased risk for VTE, despite current thromboprophylaxis (blood thinner) guidelines

  • In Canada, the cost for treatment of blood clots and associated complications is $600 million per year

Individualized Risk Assessment

Central to this program is the use of serial thrombelastography (TEG) analysis to assess each trauma patient’s individual risk for blood clots throughout their recovery.

  • TEG is a point-of-care tool that can be used to quantify trauma-induced coagulopathy

  • We are critically evaluating the potential benefit of a personalized approach using TEG analysis to customized interventions, such as prescription of blood thinning medication to reduce the risk of venous thromboembolism (VTE) after injury

Some of our translational laboratory research program’s novel discoveries include:

  • An elevated maximal amplitude value (a measure of clot strength) from TEG analysis is predictive of VTE in trauma patients (J Orthop Trauma 2016)

  • Improved outcomes with TEG-informed resuscitation (Injury 2020)

  • Increased VTE risk exists after hip fracture beyond 6-weeks post-operatively (Can J Surg 2020)

  • TEG analysis can measure antiplatelet effect and that ASA (aspirin) decreases platelet hyperactivity after hip fracture surgery (Orthopaedic Research Society 2023 podium presentation)

  • Elevated Activated Clotting Time from TEG analysis was predictive of VTE complications after hip fracture (2023 Orthopaedic Trauma Association Highlight Paper Award)

Impact of Personalized Care

There is potential to revolutionize the management of coagulopathy in trauma patients, leading to more targeted and effective treatments.

CLINICAL TRIALS

We are leaders in multi-centre clinical trials that have led to transformational improvements in patient outcomes. A few examples of our contributions to improving evidence-based orthopaedic care:

  • Improved reduction of the ankle syndesmosis joint is achieved using dynamic stabilization with a suture button construct compared to traditional screw fixation (2017 OTA Highlight Paper, J Orthop Trauma 2019)

  • A single screw is safe and effective compared to double screw fixation for medial malleolar fractures (J Orthop Trauma 2018)

  • A sub-meniscal arthrotomy improves the medium-term patient outcome after of tibial plateau fracture fixation (Knee Surgery, Sports Traumatology, Arthroscopy 2019)

  • Addition of fibular fixation for patients with same-level tibia and fibula fractures can save surgical time and reduce the complexity of tibial reduction without increased risk for complications (2022 OTA Highlight Paper)

  • Operative treatment of humeral diaphyseal fractures results in earlier return to work and function in the correctly selected patients (2022 OTA Highlight Paper)

  • Operative treatment of ulnar diaphyseal fractures results in earlier return to work and function in the correctly selected patients (2024 OTA Highlight Paper)

Ongoing randomized controlled trials:

  • FIRM Trial: randomization to retention vs. removal of implants following Lisfranc injury fixation (70 of 100 patients enrolled)

  • HIP PRO Trial: randomization to 1 of 2 oral medications for prevention of blood clots after hip fracture (enrollment ongoing)

Ongoing prospective clinical studies:

  • Prospective Clavicle Study: evaluation of the functional recovery after dual plating for clavicle fracture fixation and immediate weightbearing

  • COTS-H - Canadian Orthopaedic Trauma Society – Hip Score: development of a novel patient-reported outcome measure for young patients with hip and acetabular trauma (135 patients enrolled, follow-ups in progress)

  • Hip Pathway: implementation of a hip fracture care pathway for timely surgical care of those on pre-injury oral anticoagulation

DIGITAL HEALTH SOLUTIONS

INNOVATIONS:

  • Implementation and evaluation of multi-disciplinary care pathways for patients with osteoporosis

  • Novel digital health solutions for addressing clinical care gaps in fragility fracture prevention

  • Biomechanical testing of orthopaedic implant configurations to optimizefracture healing

POWER Program

The POWER (Preventing Osteoporosis With Early Recognition) Program is the first Osteoporosis Canada registered outpatient fracture liaison service in Alberta — and just one of seven in Canada.

To date, 361 patients have participated in this program. The mandate of the POWER Program is to partner with our patients to prevent them from experiencing future fragility fractures. By assessing, educating, investigating, and initiating appropriate osteoporosis treatments, we can empower our patients and provide them with personalized tools and services to optimize their lifelong bone health. Given the success and cost-savings of this program, we are striving for provincial-level implementation, with the ultimate goal of international-level implementation.

Bone Health Mobile Phone Application for Patient Self-Directed Use
Our patient-informed phone application (app) will help patients navigate the POWER Program, access educational materials, and schedule reminders for their osteoporosis medications. We are pioneering this digital health solution to address clinical care gaps in bone health and the prevention of fragility fractures.

BIOMECHANICS

Dual Plating of Clavicle Fractures

  • Dual plating using mini-fragment plates is biomechanically superior compared with a single superiorly placed 3.5-mm plate and has biomechanical properties similar to those of a single 3.5-mm plate placed anteriorly

  • With the exception of axial stiffness, no significant differences were found when different dual-plating constructs were compared, supporting that a patient- and fracture-specific dual plating construct may be used

This research has led to an ongoing prospective cohort study of patients requiring clavicle fixation in order to study the safety and efficacy of immediate weightbearing after dual plating technique (over 70 participants have enrolled)

Dual Plating of Humeral Diaphyseal Fractures

  • Dual-plate constructs have higher stiffness for axial loading, medial bending, and torsion

  • No significant differences were found when different dual-plating constructs were compared, supporting that a patient-and fracture-specific dual plating construct may be used

This research has informed the design of a planned prospective cohort study of patients requiring humerus fixation in order to study the safety and efficacy of immediate weight-bearing after dual plating technique in those with concomitant lower extremity injuries.

Optimal Proximal Femur Fixation

  • Ongoing testing of 6 constructs to help inform clinical research study design