Der Unfallchirurg
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Avulsion injuries of the proximal hamstring muscles are rare but very severe injuries to the dorsal thigh musculature. ⋯ In view of the poor results of nonsurgical treatment and the clearly positive reports of surgical success, open refixation is recommended for recent proximal hamstring ruptures.
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The importance of the apophyseal plates during growth is often underestimated. They act as a muscular insertion and influence the joint mechanics by the load-dependent change in shape. ⋯ Conservative management by reduced (partial) weight bearing and physiotherapy represents the gold standard in treatment. In cases with a fragment displacement >1.5-2.0 cm and in competitive athletes an open reduction should be considered.
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Injuries of the thigh muscles are among the most frequent sports injuries. For example, in soccer they represent nearly 30% of all injuries. The rectus femoris muscle is particularly exposed to injury due to its anatomical features. While distal ruptures involve the quadriceps tendon and are among the more frequent injuries not only in sports, proximal ruptures represent a rarity. Because of the mostly indifferent clinical signs, the diagnosis is often delayed. In the literature various versions of classifications on the grading of muscle injuries have been described. ⋯ The comparison of the individual studies is made difficult due to the low case numbers and nonuniform classification systems. A valid treatment algorithm can only be derived with difficulty based on the currently available data.
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Avulsion injuries of the tendon-bone junction of the adductor longus are rare. Avulsions of the iliopsoas tendon insertion on the lesser trochanter are even rarer. Avulsion injuries of the adductor insertion occur predominantly in active athletes. ⋯ Reinsertion for adductor longus tendon avulsion injuries is usually performed by open repair using various anchor systems, while extensive avulsion injuries or non-unions of the apophysis of the lesser trochanter are treated by refixation by cannulated screw systems or resection and anchor refixation of the tendon. The postoperative outcome in most cases is described as good or very good (excellent). No major complications were reported in both groups.
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Manual medicine is the medical discipline that comprehensively deals with the diagnosis, treatment and prevention of reversible functional disorders of the musculoskeletal system and other related organ systems. The article illustrates the neuroanatomical and neurophysiological basic elements and mechanisms of manual medical diagnostics and treatment. Based on the most recent literature and in consideration of various scientific guidelines, the evidence-based effectiveness of manual medical procedures is presented. ⋯ Clinical case examples illustrate the clinical approach. The terminology, origin and clinical presence of "osteopathy" are described in detail and the national and international associations and societies of manual medicine, the German Society for Manual Medicine (DGMM), the European Scientific Society of Manual Medicine (ESSOMM) and the Fédération Internationale de Medicine Manuelle (FIMM) are lexically presented. Finally, contraindications for manual interventions and an outlook on requirements and possibilities of the scientific analysis of pain are presented, as they are postulated in the preamble of the guidelines on specific low back pain of the German Society for Orthopedics and Orthopedic Surgery (DGOOC).