Steven Green, M.D.

Correction of the claw hand
Sapienza, Anthony; Green, Steven
2012 Feb;28(1):53-66, Hand clinics
Intrinsic paralysis can be the manifestation of a variety of pathologic entities (stroke, cerebral palsy, Charcot-Marie-Tooth, muscular dystrophy, leprosy, trauma, cervical disease, and compressive and metabolic neuropathies). Patients present with a spectrum of clinical findings dependent on the cause and severity of the disease. The 3 main problems caused by intrinsic weakness of the fingers are clawing with loss of synchronistic finger flexion, inability to abduct/adduct the digits, and weakness of grip. Clawing is defined as hyperextension of the metacarpophalangeal joints and flexion of the interphalangeal joints. This article describes the clinical evaluation and surgical treatment options for claw hand
— id: 141988, year: 2012, vol: 28, page: 53, stat: Journal Article,

Comparison of bare-metal and drug-eluting stents in patients with chronic kidney disease (from the NHLBI dynamic registry)
Green S.M.; Selzer F.; Mulukutla S.R.; Tadajweski E.J.; Green J.A.; Wilensky R.L.; Laskey W.K.; Cohen H.A.; Rao S.V.; Weisbord S.D.; Lee J.S.; Reis S.E.; Kip K.E.; Kelsey S.F.; Williams D.O.; Marroquin O.C.
2011 ;108(11):1658-1664, American journal of cardiology
Patients with chronic kidney disease (CKD) have a disproportionate burden of coronary artery disease and commonly undergo revascularization. The role and safety of percutaneous coronary intervention (PCI) using drug-eluting stents (DESs) verses bare-metal stents in patients with CKD not on renal replacement therapy has not been fully evaluated. This study investigated the efficacy and safety of DES in patients with CKD not on renal replacement therapy. Patients were drawn from the National Heart, Lung, and Blood Institute Dynamic Registry and were stratified by renal function based on estimated glomerular filtration rate (GFR). Of the 4,157 participants, 1,108 had CKD ('low GFR' <60 ml/min/1.73 m²), whereas 3,049 patients had normal renal function ('normal GFR' <60 ml/min/1.73 m²). For each stratum of renal function we compared risk of death, myocardial infarction, or repeat revascularization between subjects who received DESs and bare-metal stents at the index procedure. Patients with low GFR had higher 1-year rates of death and myocardial infarction and a decreased rate of repeat revascularization compared to patients with normal GFR. Use of DESs was associated with a decreased need for repeat revascularization in the normal-GFR group (adjusted hazard ratio 0.63, 95% confidence interval 0.50 to 0.79, p <0.001) but not in the low-GFR group (hazard ratio 0.69, 95% confidence interval 0.45 to 1.06, p = 0.09). Risks of death and myocardial infarction were not different between the 2 stents in either patient population. In conclusion, presence of CKD predicted poor outcomes after PCI with high rates of mortality regardless of stent type. The effect of DES in decreasing repeat revascularization appeared to be attenuated in these patients. 2011 Elsevier Inc. All rights reserved
— id: 141788, year: 2011, vol: 108, page: 1658, stat: Journal Article,

Madelung's deformity: a review
Dubey, A; Fajardo, M; Green, S; Lee, S K
2010 Mar;35(3):174-181, Journal of hand surgery (British volume)
Madelung's deformity is a rare condition of the wrist characterized by a shortened distal radius with volar-ulnar curvature and a dorsally prominent distal ulna. It occurs predominantly in adolescent females who present with pain, decreased wrist mobility, and deformity. Although its aetiology remains unclear, its treatment is becoming more refined. Several different surgical techniques have recently been described in the literature. This review addresses Madelung's deformity and suggests an algorithm for management based on current literature and the authors' own clinical experience
— id: 107767, year: 2010, vol: 35, page: 174, stat: Journal Article,

Intraosseous and extraosseous attachments of flexor tendon to bone: a biomechanical in vivo study in rabbits
Green, Steven M; Posner, Martin A
2009 Nov;38(11):E170-E172, American journal of orthopedics (Belle Mead, NJ)
There are 2 popular methods of repairing flexor tendons to the distal phalanx and attaching a free tendon graft to bone: intraosseous, by implanting the tendon into a bony tunnel, and extraosseous, by suturing the tendon to the cortical surface after elevating the periosteum. An in vivo study was designed to determine whether one method is stronger than the other. The profundus flexor of the third and fourth toes of the hind paw of adult rabbits was divided and reattached to the middle phalanx using either an intraosseous tunnel or an extraosseous suture. Half the rabbits were killed after 3 weeks, the other half after 8 weeks. Repairs were then tested to failure, using an Instron device, and compared with the same tendons in the nonoperated limbs. The repaired tendons demonstrated similar strength 3 weeks and 8 weeks after surgery but were significantly weaker than the nonoperated tendons. The importance of this study is that it gives equal credence to these usual methods of tendon attachment
— id: 106105, year: 2009, vol: 38, page: E170, stat: Journal Article,

Safety and efficacy of the infraclavicular nerve block performed at low current
Keschner, Mitchell T; Michelsen, Heidi; Rosenberg, Andrew D; Wambold, Daniel; Albert, David B; Altman, Robert; Green, Steven; Posner, Martin
2006 Jun;6(2):107-111, Pain practice
It has recently been suggested that peripheral nerve or plexus blocks performed with the use of a nerve stimulator at low currents (<0.5 mA) may result in neurologic damage. We studied the infraclavicular nerve block, performed with the use of a nerve stimulator and an insulated needle, in a prospective evaluation of efficacy and safety. During a one-year period, 248 patients undergoing infraclavicular nerve block were evaluated for block success rate and incidence of neurologic complication. All blocks were performed with the use of a nerve stimulator and an insulated needle at < or =0.3 mA. Success rate was 94%, which increased to 96% with surgical infiltration of local anesthetic. There were no intraoperative or immediate postoperative complications noted. After one week, only one patient had a neurologic complaint, and this was surgically related, referable to surgery performed on the radial nerve. We conclude that infraclavicular nerve blocks performed at low currents (< or =0.3 mA) are safe and effective
— id: 71211, year: 2006, vol: 6, page: 107, stat: Journal Article,

Thumb metacarpophalangeal ulnar collateral ligament injuries: a biomechanical simulation study of four static reconstructions
Lee, Steve K; Kubiak, Erik N; Lawler, Ericka; Iesaka, Kazuho; Liporace, Frank A; Green, Steven M
2005 Sep;30(5):1056-1060, Journal of hand surgery (American volume)
PURPOSE: To determine the optimal tunnel placement positions for tendon graft reconstruction of chronic thumb metacarpophalangeal (MCP) ulnar collateral ligament injuries that would stabilize the joint while maintaining motion. METHODS: Four commonly used tunnel placement methods were simulated on a cadaveric model using fresh-frozen thumbs and a suture/screw construct. The methods were as follows: (1) triangular configuration with apex proximal, (2) triangular configuration with apex distal, (3) cruciate configuration, and (4) parallel configuration. Stability was tested by valgus loading at 0 degrees and 30 degrees , and range of motion was tested by loading the thumb tendons. Statistical analysis was performed by 1-way analysis of variance testing. RESULTS: Valgus load stability testing at 0 degrees and 30 degrees showed that all 4 reconstruction methods stabilized the MCP joint compared with the fully sectioned state. The amount of stability achieved was not significantly different between the 4 methods. Only the reconstruction method, however, with a triangular configuration with the apex proximal restored flexion/extension range of motion not significantly different from the intact state. The other 3 methods resulted in significantly decreased range of motion. CONCLUSIONS: The reconstruction tunnel positioning of triangular configuration with apex proximal stabilizes the thumb MCP joint while maintaining flexion/extension range of motion. We recommend this configuration for chronic MCP joint injuries in which the native ulnar collateral ligament is inadequate and tendon graft reconstruction is performed
— id: 61262, year: 2005, vol: 30, page: 1056, stat: Journal Article,

A meta-analysis of the literature on distal radius fractures: review of 615 articles
Paksima, Nader; Panchal, Anand; Posner, Martin A; Green, Steven M; Mehiman, Charles T; Hiebert, Rudi
2004 ;62(1-2):40-46, Bulletin (Hospital for Joint Diseases)
A structured meta-analysis of the available literature was performed to evaluate the outcome of the treatment of displaced intra-articular fractures of the distal radius. A comprehensive search of Medline using the key words 'radius' and 'fracture' revealed over 4,000 articles. After limiting the search to clinical trials in English and excluding pediatric and geriatric age groups as well as biomechanical and animal studies, 615 abstracts were identified in the period from 1976 to May 1998. Thirty-one articles met the inclusion and exclusion criteria. These included two prospective randomized comparative trials, two non-randomized comparative trials, one half prospective case series and half historical control, and 27 papers on case series. Four papers dealt with external fixation versus closed reduction and cast treatment and one paper looked at open reduction internal fixation with or without additional external fixation. There was insufficient data to perform a scientific meta-analysis because of the poor quality of the studies and lack of a uniform method of outcome assessment. However, the data from the comparative trials showed that external fixation was favored over closed reduction and casting. Additionally, comparing the results of the case series showed that external fixation was superior to internal fixation
— id: 47335, year: 2004, vol: 62, page: 40, stat: Journal Article,

Intratendinous rupture of a flexor tendon graft many years after staged reconstruction: a report of three cases
Eshman, S J; Posner, M A; Green, S M; Meals, R A
2000 Nov;25(6):1135-1139, Journal of hand surgery (American volume)
Three cases of rupture of a flexor tendon graft many years after surgery are presented. Two cases occurred 12 years after reconstruction and the third case occurred 21 years after reconstruction. Each rupture was intratendinous, just proximal to the flexor tendon sheath in 2 cases and at the proximal edge of the transverse carpal ligament in the third case. Active digital flexion was restored by transfer of the flexor digitorum superficialis from an adjacent finger to the distal tendon stump or by direct end-to-end repair of the rupture site reinforced with an onlay autogenous patch graft. Patients undergoing tendon grafting should be alerted to the possibility of rupture, even many years later
— id: 145551, year: 2000, vol: 25, page: 1135, stat: Journal Article,

Compressive radial neuropathies
Plate AM; Green SM
2000 ;49(10):295-304, Instructional course lectures (American Association of Orthopaedic Surgeons)
Radial neuropathy can have one of several clinical presentations, depending on the level of compression: high radial nerve palsy, PIN palsy, radial tunnel syndrome, and Wartenberg's syndrome. Elucidating the history and progression of symptoms with a physical examination directed at testing individual muscles will determine the approximate anatomic level of radial injury. Identification of a Tinel's sign will often locate the site of compression. Electrodiagnostic studies can confirm the diagnosis in a radial motor neuropathy, but are unreliable in radial tunnel syndrome and sensory radial nerve compression. A trial of nonsurgical treatment is warranted in all cases except those with progressive motor weakness or palsy. Patients who do not respond or continue to progress despite conservative treatment are candidates for surgical decompression
— id: 36176, year: 2000, vol: 49, page: 295, stat: Journal Article,

Maternal smoking during pregnancy and the risk of conduct disorder in boys
Wakschlag, L S; Lahey, B B; Loeber, R; Green, S M; Gordon, R A; Leventhal, B L
1997 Jul;54(7):670-676, Archives of general psychiatry
BACKGROUND: Previous animal and human studies have indicated that prenatal exposure to nicotine is associated with adverse reproductive outcomes, including altered neural structure and functioning, cognitive deficits, and behavior problems in the offspring. Our study extends previous research on humans by controlling a broad range of correlates of maternal smoking during pregnancy to determine if smoking is associated with behavior problems in the offspring severe enough to qualify for DSM-III-R diagnosis. METHODS: Subjects were 177 clinic-referred boys, ages 7 to 12 years at the time of the first assessment, who underwent longitudinal assessment for 6 years using annual structured diagnostic interviews. Correlates of maternal smoking during pregnancy and previously identified demographic, parental, perinatal, and family risk factors for the disruptive behavior disorders were controlled in logistic regression analyses. RESULTS: Mothers who smoked more than half a pack of cigarettes daily during pregnancy were significantly more likely to have a child with conduct disorder (odds ratio, 4.4; P = .001) than mothers who did not smoke during pregnancy. This association was statistically significant when controlling for socioeconomic status, maternal age, parental antisocial personality, substance abuse during pregnancy, and maladaptive parenting. CONCLUSIONS: Maternal smoking during pregnancy appears to be a robust independent risk factor for conduct disorder in male offspring. Maternal smoking during pregnancy may have direct adverse effects on the developing fetus or be a marker for a heretofore unmeasured characteristic of mothers that is of etiologic significance conduct disorder
— id: 104197, year: 1997, vol: 54, page: 670, stat: Journal Article,

Ilizarov technique in treatment of congenital hand anomalies. Two case reports
Atar D; Lehman WB; Posner M; Paley D; Green S; Grant AD; Strongwater AM
1991 Dec;(273):268-274, Clinical orthopaedics & related research
An Ilizarov apparatus was successfully used in the treatment of a six-year-old child with a radially deviated hand caused by congenital pseudoarthrosis of the distal radius after previous traditional surgery failed. The limb length was restored, the pseudoarthrosis healed, and the deviated hand corrected. A second child, five years old, with Poland's syndrome, had a 90 degrees flexion contracture of the wrist that was treated with the Ilizarov apparatus. The flexion contracture was gradually corrected. It seems that the Ilizarov apparatus can be an important tool in the treatment of complex limb deformities
— id: 61310, year: 1991, vol: , page: 268, stat: Journal Article,