Pre-Operative and intra-operative considerations utilizing intramedullary nails for the treatment of tibial shaft fractures below total knee arthroplasty
Stevens, Nicole M; Tyler, Andrew F; Mitchell, Phillip M; Stinner, Daniel J
Clinical and Radiographic Comparison of Splinting Constructs for Distal Radius Fractures: an Effort to Free the Elbow
Stevens, Nicole M; Pean, Christian; Norris, Zoe; Tejwani, Nirmal
OBJECTIVES/OBJECTIVE:To compare short term functional outcomes, reduction loss, and rates of surgery for distal radius fractures initially immobilized with a traditional sugartong splint vs clamshell splint freeing the elbow. DESIGN/METHODS:Prospective Randomized Trial. SETTING/METHODS:Level 1 Trauma Center. PATIENTS/METHODS:Eighty-nine consecutive patients sustaining distal radius fractures were enrolled between 2018 and 2020. Short term first follow up (1-2 weeks) radiographic parameters and 6 weeks for functional questionnaires were established to assess initial outcomes. MAIN OUTCOME MEASURES/METHODS:Reduction loss based on radiographic criteria, rate of surgery, short term patient functional outcome using the DASH score. RESULTS:There were no differences noted in DASH scores (p-value=0.8) or loss of reduction (p-value=0.69) and splint type was not correlated with likelihood to have surgery (p=0.22). A binomial regression model demonstrated splint type was not a significant predictor variable of loss of fracture reduction in the regression model. CONCLUSIONS:These results suggest both sugartong splint and clamshell splint construct are acceptable options in the acute management of distal radius fractures. LEVEL OF EVIDENCE/METHODS:Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Sternoclavicular Joint Reconstruction for Medial Clavicle Fracture Nonunion
Stevens, Nicole M; Pflug, Emily; Lowe, Dylan T; Leucht, Philipp
SUMMARY/CONCLUSIONS:Operative management of sternoclavicular fracture-dislocations is recommended in the setting of symptomatic nonunion. Treatment options include open reduction internal fixation, fragment excision, and ligamentous reconstruction. We present a 29-year-old man with a medial clavicle fracture nonunion that previously failed open reduction internal fixation and was treated with sternoclavicular joint reconstruction using tendon allograft.
Repair of Humeral Shaft Nonunion With Plate and Screw Fixation and Iliac Crest Bone Graft [Case Report]
Stevens, Nicole M; Schultz, Blake J; Lowe, Dylan T; Egol, Kenneth A
SUMMARY:A 58-year-old woman with a proximal 1/3 humeral shaft nonunion presented 2 years after initial injury. We present a technique for nonunion repair, including nonunion site preparation, direct compression of the fracture site using plate osteosynthesis, and iliac crest bone graft harvest and utilization. The purpose of this video is to review humeral shaft nonunion literature and describe our management technique.
Are Arthroplasty Procedures Really Better in the Treatment of Complex Proximal Humerus Fractures? A Comprehensive Meta-Analysis and Systematic Review
Pizzo, Richard A; Gianakos, Arianna L; Haring, Richard Sterling; Gage, Mark J; Stevens, Nicole M; Liporace, Frank A; Yoon, Richard S
OBJECTIVE:A meta-analysis and systematic review was performed to compare outcomes of open reduction and internal fixation (ORIF), hemiarthroplasty (HA), and reverse total shoulder arthroplasty (rTSA) for complex proximal humerus fractures. Data sources: MEDLINE, Embase, and Cochrane Library databases were screened. Search terms included reverse total shoulder arthroplasty, open reduction internal fixation, hemiarthroplasty, and proximal humerus fracture. STUDY SELECTION:English-language studies published within the past 15 years evaluating outcomes of ORIF, rTSA, or HA for complex proximal humerus fractures with minimum of 1-year follow-up were included, resulting in 51 studies with 3064 total patients. Review articles, basic science studies, biomechanical studies, and cadaveric studies were excluded. DATA EXTRACTION:The methodological quality of evidence was assessed using the Jadad scale and methodological index for nonrandomized studies. DATA SYNTHESIS:Demographic data were compared using the Ï‡2 test. Mean data were weighted by study size and used to calculate composite mean values and confidence intervals. Continuous data were compared using the Metan module with fixed effects. Count data were compared using the Kruskal-Wallis test. Alpha was set at 0.05 for all tests. CONCLUSIONS:Patients undergoing rTSA had lower risks of complication (relative risk 0.41) and reoperation (relative risk 0.28) than HA patients. rTSA resulted in higher Constant scores (standard mean difference 0.63) and improved active forward flexion when compared with HA (standard mean difference 0.76). Pooled mean data demonstrated better outcome scores and active forward flexion of ORIF versus HA and rTSA, although the patients were younger and had more simple fracture patterns. LEVEL OF EVIDENCE:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Distal Humerus Fractures Evolution of Management
Stevens, Nicole M
Distal humerus fractures are a challenging problem that has vexed many orthopedic surgeons through the years. This article reviews the historical management of distal humerus fractures from nonoperative treatment to prolonged traction with ice tongs to the advent of AO technique and beyond. Current controversies, including plate orientation, ulnar nerve management, and the role of arthroplasty, are reviewed. Based on the best available evidence, parallel plating has been shown to be biomechanically superior, but no differences have been found in clinical outcomes, and the surgeon should let the fracture pattern dictate plate placement. The evidence surrounding ulnar nerve management is controversial, but a systematic review has shown no benefits to routine transposition. Finally, total elbow arthroplasty is an excellent option in geriatric fractures with osteoporotic bone and should be considered in these cases. Ultimately, distal humerus fractures, especially in the geriatric population, remain a difficult problem, but with meticulous technique and stable restitution of the bony columns and tie arch, good outcomes can be obtained.
Incidence of Osteomyelitis in Sacral Decubitus Ulcers and Recommendations for Management
Crespo, Alexander; Stevens, Nicole M; Chiu, Ernest; Pham, Vinh; Leucht, Philipp
High-energy Lateral Compression Type 1 Injuries of the Pelvis: A Spectrum of Injury
Tejwani, Nirmal; Stevens, Nicole M; Ganta, Abhishek
Lateral compression type 1 pelvic fractures comprise a spectrum of injuries of varying stability. The clinician should be cognizant of signs and symptoms of instability including complete sacral fractures, bilateral ramus fractures, displacement greater than 1 cm, high-energy mechanism, and inability to bear weight. Management of these injuries is controversial, but the clinician should consider examination under anesthesia and potentially surgical stabilization.
Commonly Missed Injuries in the Patient with Polytrauma and the Orthopaedist's Role in the Tertiary Survey
Stevens, Nicole M; Tejwani, Nirmal
Nail Plate Combination (NPC) Treatment for infected, charcot ankle fracture malunion
Chapter by: Stevens, Nicole M.; Yoon, Richard S.; Liporace, Frank A.
in: Fractures of the Foot and Ankle: A Clinical Casebook by
[S.l.] : Springer International Publishing, 2017