Der Unfallchirurg
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The medical assessment of affections of the apophyses frequently presents the assessor with problems in causality testing and estimation of functional impairment. Apophyses are the insertion of tendons and are therefore at the center of an acting parallelogram of forces. They fuse via an apophyseal plate in the second decade of life. ⋯ Once the mineralization is complete, this type of fracture no longer occurs. Osgood-Schlatter disease, an insertion tendinosis of the patellar tendon, occurs in around 20% of all sport-active adolescents but it is questionable whether it can be associated with the acute avulsion fracture. Knowledge of the pathogenesis of affections and injuries of the apophysis can provide the assessor with good foundations for the estimation of a causal association.
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Review Case Reports
[Acute rupture of the pectoralis major muscle at the musculotendinous junction : Case report of a rare injury and literature review].
Rupture of the pectoralis major muscle (PMR) is a rare injury that occurs primarily during strength training. The case of a 31-year-old professional basketball player who suffered a rupture of the pectoralis major muscle (PM) at the myotendinous junction while performing bench presses is presented. ⋯ The patient returned to playing basketball pain-free with full range of motion 3 months following refixation of the PM. This article discusses the distinct characteristics of this injury in the context of the current literature and the operative approach is presented in detail.
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Numerous predisposing factors are known for patellar dislocations but the extent to which these or the trauma cause the dislocation is often unclear. ⋯ The predisposition rate in infantile patellar dislocations is high; however, falls are always significant accident events as well as medial direct impact. Torsional trauma is also a significant causative factor, unless high-grade trochlear dysplasia is present, whereas trivial traumas are not.
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Review
[Investigation of the reduction in the disability after fractures in children and adolescents].
The student accident insurance has been part of the German Statutory Accident Insurance (Deutsche Gesetzliche Unfallversicherung, DGUV) for 50 years. In order to assess the reduction in working capacity (Minderung der Erwerbsfähigkeit, MdE) in the event of permanent consequences of accidents and injuries, the recommendation to treat the affected child or adolescent "as an average adult" is currently still valid. The present work deals with the everyday practice of the MdE assessment in children and adolescents and their weaknesses through the transfer of the principles from adulthood. In addition, proposals for the adaptation of the assessment principles for the growth age are drawn up.
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Legal appraisals of possible treatment errors in childhood and adolescence are rare, often refer to the treatment of trauma of the upper limbs and are frequently recognized. From the activity of the first author as an expert witness 31 expert opinions (25%) referred to the upper limbs. Supracondylar humeral fractures, radius neck fractures, radial condyle fractures and distal radius fractures were predominant. ⋯ Insufficient recognition of instability (radial condyle), inadequate reduction and inadequate stabilization (radius neck, supracondylar) as well as untreated malalignments and secondary dislocations (wrist) were the main reproaches. Poor communication and deficient documentation often aggravate the situation. Working along clear algorithms can help to avoid legal proceedings and assignment of guilt.