Der Unfallchirurg
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A pneumocephalus caused by a subarachnoid pleural fistula following spinal surgery using an anterior approach is a rare complication, especially in vertebral body replacement. We report the case of a 66-year-old male suffering from metastatic prostatic cancer of the thoracic spine who underwent replacement of a vertebral body using a transthoracic approach. A pneumocephalus occurred 4 weeks postoperatively resulting in delirium.
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Prevention of venous thromboembolism has become an integral component of trauma surgery treatment and consists of physical and pharmacological measures. The indications and choice of prophylaxis modalities depend on the patient's individual risk profile which is determined by the combination of exposing and predisposing risk factors. ⋯ This review summarizes the recommendations of the German S3 guidelines relating to trauma surgery and also discusses the amendment referring to the registration of the new oral anticoagulants rivaroxaban and dabigatran etexilate. The availability of these new compounds increases the spectrum of prophylaxis modalities thereby creating a need for new information in trauma surgery.
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Neuraxial blockade confers benefits to surgical patients not only due to the high analgesic quality but also through a reduction in postoperative complications, such as respiratory insufficiency and a shortening of postoperative paralytic ileus. In orthopedic surgery peripheral and neuraxial blockades are extensively used to enhance postoperative mobilization. The most serious complication of neuraxial blockade is spinal epidural hematoma, which may lead to permanent paraplegia if left untreated. ⋯ Most national societies have issued guidelines with specific time intervals between application of antithrombotic drugs and subsequent neuraxial blockade to minimize this risk. From the viewpoint of an anesthesiologist it is preferable to start with chemical thromboembolism prophylaxis postoperatively as opposed to preoperatively, to administer all drugs in the evening and to limit the number of available drugs at each site. The safety of neuraxial blockade in the presence of the new oral anticoagulant rivaroxaban is currently unknown due to limited experience and dabigatran is considered contraindicated with indwelling epidural catheters according to the manufacturer.
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This article for continuing education describes ligamentous injuries of the upper cervical spine. Functional radiological imaging studies are particularly important in the diagnostic workup. ⋯ The incidence, classification, diagnostic workup, standard treatment, and characteristics of the individual ligamentous injuries are presented. In addition, the topic of combined injuries of the upper cervical spine is addressed.