OREF: Supporting Research to Improve Lives

By: Lisa Applegate

Grants enable investigators to explore complex questions

When she was in medical school, Carol A. Lin, MD, MA, wasn’t interested in orthopaedics. She thought cardiac or pediatric surgery would have a greater impact on patients’ lives. But that was before she met a 7-year-old girl from Malawi.


Carol A. Lin, MD, MA

Dr. Lin spent a year in the impoverished African country as a pediatric nutrition researcher. What really struck her were the vast number of untreated orthopaedic problems she saw among the Malawians.

“In a place where your life depends on being able to work and walk for miles, disabilities are not only hard on the patient but can affect the whole family’s survival,” said Dr. Lin.

Now a clinician researcher at Cedars-Sinai Orthopaedic Center in Los Angeles, Dr. Lin still remembers that 7-year-old girl who likely had a septic knee in infancy and, as a result, had a 90-degree flexion contracture. The girl’s mother had to carry her everywhere and believed her daughter would be disabled for life.

Dr. Lin, recipient of a 2012 Orthopaedic Research and Education Foundation (OREF)/Zimmer Young Investigator Grant, was able to bring the girl and her mother to a British-run hospital. Curious, Dr. Lin viewed the girl’s radiographs and listened to surgeons develop a plan for her treatment.

“They performed three or four surgeries, and by the end of it, she had a straight leg and was able to walk,” said Dr. Lin. “She went from someone who was completely disabled to having a much more functional life. And it was due to orthopaedic surgery.”

Thinking outside traditional research
Her experience in Malawi led Dr. Lin to becoming an orthopaedist and clinician scientist. Dr. Lin wanted to explore whether any information could be gleaned from patients who were not included in research studies but were being treated at centers involved in multicenter studies. With the OREF/Zimmer grant, Dr. Lin compared patients who participated in the Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT) to tibial fracture patients who were not enrolled.

Thanks to the OREF/Zimmer funding, Dr. Lin was able to involve six of the 27 SPRINT centers, comparing 300 patients enrolled in the study to about 130 patients treated at the same centers who were eligible to participate but chose not to enroll.

Although the numbers were too small to reach statistical significance, Dr. Lin did discover some useful steppingstones for future research. Although unenrolled patients with nonunions were slightly more likely to undergo reoperation within 6 months of surgery than enrolled patients, both groups had much lower reoperation rates than those previously reported. This suggests that a center’s involvement in a study could affect the treatment of patients who were not enrolled.

“A lot of questions have answers based on history or tradition that we don’t necessarily have robust evidence to support,” said Dr. Lin. Grants such as the OREF/Zimmer grant enable the investigator to be critical of one’s own process and “add something to the body of knowledge,” asserted Dr. Lin, which is why she believes OREF is vital to the continued advancement of orthopaedic surgery. “Most of the time, when people have a question but don’t have an easy answer, they say, ‘Well, that’s an interesting question,’ and then they move on,” said Dr. Lin “I think those hard to answer questions are the ones we should tackle.

“OREF’s greatest strength is that it gives people the chance to pursue those questions,” she added.      

Lisa Applegate is a contributing writer for OREF. She can be reached at communications@oref.org