Der Unfallchirurg
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Injuries to the subaxial cervical spine are increasing and have a high risk for neurological injury in comparison to the thoracic and lumbar spine. The current treatment recommendations according to the recommendations of the section spine of the German Society for Orthopaedics and Trauma (DGOU) and the S1 guidelines of the German Society for Trauma Surgery are summarized in this article. ⋯ Injuries should be classified according to the AOSpine classification for subaxial injuries. Based on this classification, a decision on a conservative or operative treatment regimen as well as individual details of the treatment can be made.
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Review
[Perioperative management in the treatment of trauma for rheumatics under immunosuppression].
With an almost 3.5% manifestation rate in Germany, rheumatoid arthritis is a relatively frequent disease. Due to the involvement of diverse locations on the skeleton and often multiple comorbidities, treatment of these patients in cases of acute trauma potentially represents a substantial risk. The anti-inflammatory drug treatment harbors dangers, such as delayed wound healing and infections in the perioperative management of these patients. ⋯ If necessary, orthopedic or internist rheumatologists should be consulted for additional support. Absolute and urgent surgical interventions do not constitute a contraindication with respect to the antirheumatic medication but should be considered in the assessment of the perioperative risk profile. A close cooperation with anesthesia, the meticulous control of intraoperative positioning and postoperative management are of particular importance.