Publications by authors named "Ebubechi Okwumabua"

6 Publications

  • Page 1 of 1

Humeral Shaft Fracture With Placement of an Intramedullary Nail Through an Unrecognized Sarcoma.

J Am Acad Orthop Surg Glob Res Rev 2021 02 19;5(2). Epub 2021 Feb 19.

From the Duke University School of Medicine, Durham, NC (Mr. Cullen, Mr. Flamant, and Mr. Ferlauto); The University of Houston Health Science Center, Houston, TX (Dr. Okwumabua); the Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC (Dr. Brigman and Dr. Eward); and Duke Cancer Institute, Durham, NC (Dr. Brigman and Dr. Eward).

Case: A 72-year-old man underwent intramedullary nailing of a humeral diaphysis fracture with passage through an unrecognized pathologic fracture. Four months later, a biopsy of a soft-tissue mass in the arm revealed pleomorphic undifferentiated sarcoma. Only after local recurrence and forequarter amputation was the story of a pathologic fracture through undifferentiated pleomorphic sarcomas of bone clear. The patient developed metastatic disease and died after 2 years postoperatively.

Discussion: Orthopaedic surgeons should consider sarcoma when assessing patients with fractures of unknown etiology and an inappropriate mechanism because the placement of an intramedullary device through a sarcoma of bone has consequences.
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February 2021

Hyperglycemia as a risk factor for postoperative early wound infection after bicondylar tibial plateau fractures: Determining a predictive model based on four methods.

Injury 2019 Nov 25;50(11):2097-2102. Epub 2019 Jul 25.

Division of Orthopaedic Trauma, Vanderbilt Medical Center, 1215st Avenue South, Nashville, TN, 37212, United States. Electronic address:

Objectives: Identify a glucose threshold that would put patients with isolated bicondylar tibial plateau fractures at risk of early wound infection (i.e. < 90 days).

Design: Retrospective review of medical records.

Setting: Academic American College of Surgeons (ACS) Level 1 trauma center.

Patients: Adult patients between 2010 and 2015 with an operatively treated isolated bicondylar tibial plateau fracture and at least three glucose measurements during their hospitalization.

Main Outcome Measurement: To predict infection using four different methods: maximum preoperative blood glucose (PBG), maximum blood glucose (MGB), Hyperglycemic Index (HGI), and Time-Weighted Average Glucose (TWAG).

Results: 126/381 patients met our inclusion criteria. Fifteen (12%) patients had an open fracture and 30/126 (23%) developed an infection. Median glucose for each predictive method studied was 114 (IQR 101.2-137.8) mg/dL for PBG, 144 (IQR 119-169.8) mg/dL for MBG, 0.8 (IQR 0.20-1.60) mmol/L for HGI, and 120.4 (IQR 106.0-135.6) mg/dL for TWAG. As expected, infected patients had higher PBG, MGB, and TWAG. HGI was similar in both groups. None of these differences prove to be statistically significant (p > .05). Logistic regression models for all the methods showed that having an open fracture was the strongest predictor of infection.

Conclusion: It is well known that stress-induced hyperglycemia increases the risk of infection, we present and compare four models that have been used in other medical fields. In our study, none of the methods presented identified a glucose threshold that would increase the risk of infection in patients with bicondylar tibial plateau fractures.

Level Of Evidence: Retrospective review, Level III. See Instructions for Authors for a complete description of levels of evidence.
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November 2019

Opiate Prescribing Practices After Common Isolated Lower Extremity Injuries.

J Orthop Trauma 2019 Mar;33(3):e93-e99

Vanderbilt Medical Center, Nashville, TN.

Objective: This retrospective study aimed at identifying opiate prescribing practices, the number of morphine milligram equivalents (MMEs) prescribed by orthopaedic and nonorthopaedic providers in patients with operatively treated isolated lower extremity fractures, and provide opiate prescribing recommendations.

Methods: Patients older than 18 years with isolated lower extremity (unicondylar, bicondylar, tibial shaft, pilon, and ankle) fractures between 2005 and 2016 were identified. Prescribing information was obtained from the State Controlled Substance Monitoring Database. Descriptive statistics were calculated for each injury and plotted for MME use. Mann-Whitney and Wilcoxon tests were used for data analysis. To aid in clinical relevance, MMEs were converted to number of pills of oxycodone 10 mg (OC 10 mg).

Results: Three hundred forty-one patients met our inclusion criteria. Mean age was 45 years; 56% (192/341) were men. Forty-seven percent (159/341) were prescribed opiates before their injury. Orthopaedic providers prescribed more opiates to patients with pilon fractures compared with unicondylar (P = 0.010), tibial shaft (P < 0.001), and ankle (P < 0.001) fractures. Bicondylar plateau fracture patients also received more opiates when compared with unicondylar (P = 0.001), tibial shaft (P < 0.001), and ankle (P < 0.001) fractures. Nonorthopaedic providers prescribed more opiates to patients with pilon fractures when compared with unicondylar (P = 0.006), bicondylar (P < 0.001), tibial shaft (P < 0.001), and ankle fractures (P = 0.006). Differences between orthopaedic and nonorthopaedic MMEs prescribed are significantly different for each injury type (<0.05).

Conclusions: Patients with pilon or bicondylar tibial plateau fractures are currently being prescribed more opiates when compared with other isolated fractures. We have developed an opiate prescription guideline based on what is being prescribed by orthopaedic providers.
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March 2019