Keloids are a frequent finding after physical trauma. Keloids of the pinna (helix and antihelix) as a complication of ear-piercing are the most difficult cases. Clinicians have tended to avoid the surgical approach, preferring local conservative treatment with corticosteroids or other treatments. We report use of intrakeloid resection and a form-pressure device to treat pinna keloids and avoid recurrence. The purpose is to maintain the form of the folds of the pinna. The recommendation for this therapy is to maintain the pressure at 24-30 mmHg, and the duration of the form-pressure therapy in our patients was about 25 weeks.
Background
Bilateral acetabular fractures constitute a rare entity, and their optimal management is unknown.
Materials and Methods
A systematic literature search was conducted in PubMed, Embase and Cochrane Library between 1995 and 2020. Inclusion criteria were studies presenting cases of bilateral acetabular fractures and reporting outcomes. Extracted data included patient demographics, injury mechanism, fracture classification, associated injuries, management and outcomes.
Results
Thirty-seven studies (47 cases; 35 males vs 12 females) were included. Mean age was 46 years old (range 13–84) and mean follow-up was 19.8 months (range 1.5–56). High-energy injuries (49%) and seizures (45%) were the most common injury mechanisms. Fracture type distribution differed according to injury mechanism. Treatment was surgical in 70% of cases (75% open reduction and internal fixation vs 25% acute total hip arthroplasty). Outcomes were excellent/good in 58% of patients. Complications included heterotopic ossification (11%), nerve injury (11%), degenerative arthritis (6%), DVT (6%), and infection (3%).
Conclusions
Bilateral acetabular fractures most commonly occur either after trauma or seizures and are commonly managed operatively. They are not devoid of complications, however, more than half (58%) achieve complete functional recovery.
The coronavirus disease 2019 (COVID-19) pandemic has led to important restrictions in social life of civilians worldwide and there were lower admission rates mainly in surgical departments in many hospitals. This study presents how COVID-19 pandemic affected admissions at the orthopaedic and trauma surgery department of a major trauma center. A retrospective study was conducted that recorded all patients examined at the outpatient orthopaedic clinic and the emergency orthopaedic department, as well as patients admitted to the orthopaedic surgery clinic and patients that underwent operative procedures between March 23 and May 4, 2020 (first lockdown period) and between March 23 and May 4, 2019 (control period). In addition, all patients with hip fractures that required hospitalization and underwent hip surgery were identified during the same time periods. During lockdown period 1 compared with the lock-down period 2 were observed: 70% and 61% decrease in the number of patients examined at the outpatient clinic and the emergency orthopaedic department respectively. The number of patients admitted to the orthopaedic surgery clinic declined by 41%, whereas operative procedures decreased by 22%. Regarding hip fractures timing to surgery during the first period was significantly less compared with second lockdown period, however, hospitalization days remained almost unchanged over the two time lockdown periods. Restrictions during the first lockdown period due to COVID-19 pandemic caused an important decrease in the number of patients and theaters in all orthopaedic departments in one of the major trauma centers in Athens. However, the incidence of hip fractures in elderly was not significantly decreased. Further similar studies are needed to identify variations and patterns of these parameters in other trauma centers.
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