introductionSurgical site infections pose a significant problem in the treatment of neurosurgical procedures, regardless of the application of perioperative prophylaxis with systemic antibiotics. The infection rate in these procedures ranges from less than 1% to above 15%. Different antibiotics and administration regimes have been used in the perioperative prophylaxis so far, and there are numerous comparative studies regarding their efficiency, however, it is generally indicated that the choice thereof should be based on information and local specifics connected to the most probable bacterial causers, which would possibly contaminate the surgical site and cause infection, and moreover, the mandatory compliance with the principles of providing adequate concentration of the drug at the time of the anticipated contamination.objective Comparing the protective effect of two perioperative prophylactic antibiotic regimes using cefuroxime (second generation cephalosporin) and ceftriaxone (third generation cephalosporin) in the prevention of postoperative surgical site infections after elective and urgent cranial and spinal neurosurgical procedures at the University Clinic for Neurosurgery in Skopje in the period of the first three months of 2016.design of the study Prospective randomized comparative study. outcome measuresEstablishing the clinical outcome represented as prevalence of superficial and deep incision and organ/space postoperative surgical site infections. Material and methodWe analyzed prospectively 40 patients who received parenteral antibiotic prophylaxis with two antibiotic regimes one hour before the routine neurosurgical cranial and spinal surgical procedures; the patients were randomized in two groups, according to the order of admission and participation in the study, alternately, non-selectively, those persons who fulfilled inclusion criteria were placed in one of the two programmed regimes with cefuroxime in the first, and cefotaxime in the second compared group. All relevant demographic and perioperative patient data were analyzed for both comparative groups, especially the factors known to cause disposition (predisposition) to infections. The prevalence of postoperative infections was evaluated as the primary outcome corresponding author: Ass. D-r Aleksandra Dimovska Gavrilovska Dr. Med

Posterior sternoclavicular joint dislocation is a rare condition. In this paper, we present a 51-year-old male patient who was admitted to the emergency department in our hospital after he was hit by a mining railway wagon in the chest. A diagnosis of posterior sternoclavicular dislocation was confirmed after performing a CT scan. Following necessary preparations, the sternoclavicular joint was stabilized with two wire cerclage techniques during open reduction. During control at the postoperative 4th week, the range of motion at the shoulder was satisfactory, but the patient had mild pain at the joint level and was sent to physical therapy to improve the range of motion and to minimize the pain.

Prevailing over in rotationally unstable pelvic fractures, acetabular fractures or hip dislocations, superior gluteal artery pseudo aneurysm imperceptibly could be found after blunt force trauma of the pelvic region. We present a case of superior gluteal artery pseudo aneurysm after blunt force trauma that became gradually symptomatic in two months following the prime malevolence. Non-resolving gluteal hematoma presented two months after the incident, disregarding standard treatment methods led the diagnosis to plausible entity of pseudo aneurysm. Standard protocol was followed. CT angiography was indicated and it confirmed the suspected diagnosis. Upon indication a treatment plan was established with correspondent angioembolization of the pathologic substrate. Pseudo aneurism of the superior gluteal artery should be considered as differential diagnosis for unexplained hematomas in the posterior pelvic region following a trauma regardless of its nature.

Cerebral venous sinus thrombosis (CVST) is presence of a blood clot in the dural venous sinuses. This is a rare, but dangerous condition. CSVT is characterized by a highly variable clinical spectrum, difficult diagnosis, variable etiologies and prognosis. The International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT) determined the frequency of the sites of SCVT. The aim of this case study was to show the clinical presentation, the examination we made, the therapy that was ordinated and the outcome of the treatment. Case study: A 14-year-old male teenager was admitted to the University Clinic for Neurosurgery in Skopje with GCS 10, accompanied with tonic-clonic epileptic seizures. CT examinations by systems were made, and during the time of recording the patient was given Dormicum 2mg overall dose. CT scan of the brain showed hyperdense zones formation around superior sagittal sinus (SSS), the rest of the medical finding was normal. We ran laboratorytests and the test for hemostasisshowed deviation from the normal range. With the ordinated therapy the clinical condition of the patient drastically improved. He was discharged home 12 days after the admission. He was given a recommendation for further check-ups by a transfusiologist and regular visits to our clinic. Occlusion of the cerebral veins and dural venous sinuses may occur on the basis of local trauma, neoplasm or infection. Primary aseptic thrombosis may involve either cerebral veins or dural venous sinuses, or both in combination. The clinical picture and the prognosis of intracranial venous thrombosis probably depend largely on the location, extent, and rapidity of development of the venous occlusion. Conclusion: Superior sagittal sinus thrombosis is a condition that can be manifested with diverse and many symptoms and signs, which often can start unexpectedly and can be life-threatening.

Fractures of the talus do not occur frequently, accounting for about 0.1% of all fractures. Failure to achieve anatomic reduction, exponentially increases the risk of postoperative aseptic osteonecrosis and posttraumatic osteoarthritis. The purpose of this study was to evaluate and compare the short-term and medium-term functional outcomes in patients who underwent open reduction and internal fixation of talus fractures. Materials and methods: At the University Clinic for Traumatology in the period between 2017 to 2020, 14 patients with talus fractures were surgically treated. The inclusion and exclusion factors were determined, all patients signed the consent and the study passed the ethics committee. Results: All patients underwent open reduction and internal fixation with screws or reconstructive plate. Follow-up was done on the 14th postoperative day, 1st month, 3rd month and 6th month. At the 6th month follow-up, the functional outcome was tested using the Kitaoka score unified by the American Orthopedic Foot and Ankle Society. This injury is too rare for conclusions to be brought out of and to be compared to larger studies. However, all major studies from reference trauma centers lead to the same conclusions, that the treatment of these fractures is complex Anatomical reduction is mandatory for a better outcome. Conclusion: A protocol for the treatment of posttraumatic osteoarthritis should be introduced, given the high rate of its occurrence despite the satisfactory surgical technique.