Der Unfallchirurg
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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.
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Multicenter Study Controlled Clinical Trial
[Operative versus conservative treatment of non-displaced fractures of the scaphoid bone. Results of a controlled multicenter cohort study].
Within a prospective, multicenter cohort study we investigated whether operative treatment of scaphoid bone fractures leads to earlier return to previous activity levels. ⋯ Operative treatment primarily facilitates earlier return to previous activity levels, as well as better functional status, less pain and higher patient satisfaction, but conservative treatment seems to be safer and associated with a lower complication rate.
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Following treatment of distal radius fractures poor functional results can still be found despite satisfactory radiological findings. This may be due to concomitant carpal lesions occurring together with these fractures. The aim of this prospective study was to analyze the clinical outcome depending on the type of fracture and concomitant carpal lesions. ⋯ The results demonstrate, if a correct restoration and surgical stabilization technique is used, clinical outcome following fractures of the distal radius also depends on an optimized management of concomitant carpal lesions.