Skip to main content
Erschienen in: Sports Medicine 10/2019

07.06.2019 | Systematic Review

Frequency and Magnitude of Game-Related Head Impacts in Male Contact Sports Athletes: A Systematic Review and Meta-Analysis

verfasst von: Jack V. K. Nguyen, James H. Brennan, Biswadev Mitra, Catherine Willmott

Erschienen in: Sports Medicine | Ausgabe 10/2019

Einloggen, um Zugang zu erhalten

Abstract

Background

Sensor devices have enabled estimations of head impact kinematics across contact sports.

Objectives

To quantitatively report the magnitude (linear and rotational acceleration) and frequency of game-related head impacts recorded in male contact sports athletes.

Methods

A systematic review was conducted in June 2017. Inclusion criteria were English-language in vivo studies published after 1990 with a study population of male athletes aged ≥ 16 years, in any sport, where athletes were instrumented with an accelerometer device for measuring head impacts. Study populations were not limited to players with a clinical diagnosis of concussion.

Results

Twenty-one studies met the inclusion criteria with 12 conducted on American Football athletes. Six of these studies were included for meta-analysis. At a threshold of 10g, amateur rugby players sustained the most impacts per player per game (mean = 77, SD = 42), followed by amateur Australian Football (mean = 29, SD = 37) and collegiate lacrosse athletes (mean = 11.5, SD = 3.6). At thresholds of greater than 14.4g, high school American Football athletes sustained between 19 (SD = 19.1) and 24.4 (SD = 22.4) impacts per player per game. Statistically significant heterogeneity was observed among the included studies, and meta-analysis of impact magnitude was limited.

Conclusions

The frequency of “head acceleration events” was quantified and demonstrated substantial variation in methodology and reporting of results. Future research with standardised reporting of head impacts and inclusion of non-helmeted sports is warranted to enable more robust comparisons across sports.

Prospero ID

CRD42017070065.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Beck A, Kerr J. The epidemiology of sports head injuries in a rural population. Br J Sports Med. 2011;45(15):A20.CrossRef Beck A, Kerr J. The epidemiology of sports head injuries in a rural population. Br J Sports Med. 2011;45(15):A20.CrossRef
2.
Zurück zum Zitat Theadom A, Starkey NJ, Dowell T, Hume PA, Kahan M, McPherson K, et al. Sports-related brain injury in the general population: an epidemiological study. J Sci Med Sport. 2014;17(6):591–6.CrossRefPubMed Theadom A, Starkey NJ, Dowell T, Hume PA, Kahan M, McPherson K, et al. Sports-related brain injury in the general population: an epidemiological study. J Sci Med Sport. 2014;17(6):591–6.CrossRefPubMed
3.
Zurück zum Zitat Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil. 2006;21(5):375–8.CrossRefPubMed Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil. 2006;21(5):375–8.CrossRefPubMed
4.
Zurück zum Zitat Meier TB, Brummel BJ, Singh R, Nerio CJ, Polanski DW, Bellgowan PS. The underreporting of self-reported symptoms following sports-related concussion. J Sci Med Sport. 2015;18(5):507–11.CrossRefPubMed Meier TB, Brummel BJ, Singh R, Nerio CJ, Polanski DW, Bellgowan PS. The underreporting of self-reported symptoms following sports-related concussion. J Sci Med Sport. 2015;18(5):507–11.CrossRefPubMed
5.
Zurück zum Zitat McCrory P, Meeuwisse W, Dvorak J, Aubry M, Bailes J, Broglio S, et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017;51(11):838–47.PubMed McCrory P, Meeuwisse W, Dvorak J, Aubry M, Bailes J, Broglio S, et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017;51(11):838–47.PubMed
6.
7.
Zurück zum Zitat Echemendia RJ, Meeuwisse W, McCrory P, Davis GA, Putukian M, Leddy J, et al. The sport concussion assessment tool 5th edition (SCAT5). Br J Sports Med. 2017;51(11):848–50.CrossRefPubMed Echemendia RJ, Meeuwisse W, McCrory P, Davis GA, Putukian M, Leddy J, et al. The sport concussion assessment tool 5th edition (SCAT5). Br J Sports Med. 2017;51(11):848–50.CrossRefPubMed
8.
Zurück zum Zitat King A. The proposed King-Devick test and its relation to the Pierce saccade test and reading levels. Available from the Carl Shepherd Memorial Library, Illinois College of Optometry, Chicago, IL. 1976. King A. The proposed King-Devick test and its relation to the Pierce saccade test and reading levels. Available from the Carl Shepherd Memorial Library, Illinois College of Optometry, Chicago, IL. 1976.
9.
Zurück zum Zitat Galetta MS, Galetta KM, McCrossin J, Wilson JA, Moster S, Galetta SL, et al. Saccades and memory: baseline associations of the King-Devick and SCAT2 SAC tests in professional ice hockey players. J Neurol Sci. 2013;328(1–2):28–31.CrossRefPubMed Galetta MS, Galetta KM, McCrossin J, Wilson JA, Moster S, Galetta SL, et al. Saccades and memory: baseline associations of the King-Devick and SCAT2 SAC tests in professional ice hockey players. J Neurol Sci. 2013;328(1–2):28–31.CrossRefPubMed
10.
Zurück zum Zitat Collie A, Maruff P, Makdissi M, McCrory P, McStephen M, Darby D. CogSport: reliability and correlation with conventional cognitive tests used in postconcussion medical evaluations. J Clin Sport Med. 2003;13(1):28–32.CrossRef Collie A, Maruff P, Makdissi M, McCrory P, McStephen M, Darby D. CogSport: reliability and correlation with conventional cognitive tests used in postconcussion medical evaluations. J Clin Sport Med. 2003;13(1):28–32.CrossRef
11.
Zurück zum Zitat Lovell M, Collins M, Podell K, Powell J, Maroon J. ImPACT: immediate post-concussion assessment and cognitive testing. Pittsburgh: NeuroHealth Systems, LLC.; 2000. Lovell M, Collins M, Podell K, Powell J, Maroon J. ImPACT: immediate post-concussion assessment and cognitive testing. Pittsburgh: NeuroHealth Systems, LLC.; 2000.
12.
Zurück zum Zitat Brennan JH, Mitra B, Synnot A, McKenzie J, Willmott C, McIntosh AS, et al. Accelerometers for the assessment of concussion in male athletes: a systematic review and meta-analysis. Sports Med. 2017;47(3):469–78.CrossRefPubMed Brennan JH, Mitra B, Synnot A, McKenzie J, Willmott C, McIntosh AS, et al. Accelerometers for the assessment of concussion in male athletes: a systematic review and meta-analysis. Sports Med. 2017;47(3):469–78.CrossRefPubMed
13.
Zurück zum Zitat Broglio SP, Eckner JT, Martini D, Sosnoff JJ, Kutcher JS, Randolph C. Cumulative head impact burden in high school football. J Neurotrauma. 2011;28(10):2069–78.CrossRefPubMedPubMedCentral Broglio SP, Eckner JT, Martini D, Sosnoff JJ, Kutcher JS, Randolph C. Cumulative head impact burden in high school football. J Neurotrauma. 2011;28(10):2069–78.CrossRefPubMedPubMedCentral
14.
Zurück zum Zitat Shultz SR, MacFabe DF, Foley KA, Taylor R, Cain DP. Sub-concussive brain injury in the Long-Evans rat induces acute neuroinflammation in the absence of behavioral impairments. Behav Brain Res. 2012;229(1):145–52.CrossRefPubMed Shultz SR, MacFabe DF, Foley KA, Taylor R, Cain DP. Sub-concussive brain injury in the Long-Evans rat induces acute neuroinflammation in the absence of behavioral impairments. Behav Brain Res. 2012;229(1):145–52.CrossRefPubMed
15.
Zurück zum Zitat Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.CrossRefPubMedPubMedCentral Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Wilcox BJ, Beckwith JG, Greenwald RM, Chu JJ, McAllister TW, Flashman LA, et al. Head impact exposure in male and female collegiate ice hockey players. J Biomech. 2014;47(1):109–14.CrossRefPubMed Wilcox BJ, Beckwith JG, Greenwald RM, Chu JJ, McAllister TW, Flashman LA, et al. Head impact exposure in male and female collegiate ice hockey players. J Biomech. 2014;47(1):109–14.CrossRefPubMed
17.
Zurück zum Zitat Cobb BR, Rowson S, Duma SM. Age-related differences in head impact exposure of 9–13 year old football players. Biomed Sci Instrum. 2014;50:285–90.PubMed Cobb BR, Rowson S, Duma SM. Age-related differences in head impact exposure of 9–13 year old football players. Biomed Sci Instrum. 2014;50:285–90.PubMed
18.
Zurück zum Zitat King D, Hume P, Gissane C, Brughelli M, Clark T. The influence of head impact threshold for reporting data in contact and collision sports: systematic review and original data analysis. Sports Med. 2016;46(2):151–69.CrossRefPubMed King D, Hume P, Gissane C, Brughelli M, Clark T. The influence of head impact threshold for reporting data in contact and collision sports: systematic review and original data analysis. Sports Med. 2016;46(2):151–69.CrossRefPubMed
19.
Zurück zum Zitat Shamliyan T, Kane RL, Dickinson S. A systematic review of tools used to assess the quality of observational studies that examine incidence or prevalence and risk factors for diseases. J Clin Epidemiol. 2010;63(10):1061–70.CrossRefPubMed Shamliyan T, Kane RL, Dickinson S. A systematic review of tools used to assess the quality of observational studies that examine incidence or prevalence and risk factors for diseases. J Clin Epidemiol. 2010;63(10):1061–70.CrossRefPubMed
20.
Zurück zum Zitat Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147(8):573–7.CrossRef Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147(8):573–7.CrossRef
21.
Zurück zum Zitat DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177–88.CrossRefPubMed DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177–88.CrossRefPubMed
22.
Zurück zum Zitat Naunheim RS, Standeven J, Richter C, Lewis LM. Comparison of impact data in hockey, football, and soccer. J Trauma Acute Care Surg. 2000;48(5):938–41.CrossRef Naunheim RS, Standeven J, Richter C, Lewis LM. Comparison of impact data in hockey, football, and soccer. J Trauma Acute Care Surg. 2000;48(5):938–41.CrossRef
23.
Zurück zum Zitat King D, Hume PA, Brughelli M, Gissane C. Instrumented mouthguard acceleration analyses for head impacts in amateur rugby union players over a season of matches. Am J Sports Med. 2015;43(3):614–24.CrossRefPubMed King D, Hume PA, Brughelli M, Gissane C. Instrumented mouthguard acceleration analyses for head impacts in amateur rugby union players over a season of matches. Am J Sports Med. 2015;43(3):614–24.CrossRefPubMed
24.
Zurück zum Zitat King D, Hecimovich M, Clark T, Gissane C. Measurement of the head impacts in a sub-elite Australian Rules football team with an instrumented patch: an exploratory analysis. Int J Sports Sci Coach. 2017;12(3):359–70.CrossRef King D, Hecimovich M, Clark T, Gissane C. Measurement of the head impacts in a sub-elite Australian Rules football team with an instrumented patch: an exploratory analysis. Int J Sports Sci Coach. 2017;12(3):359–70.CrossRef
25.
Zurück zum Zitat Reynolds BB, Patrie J, Henry EJ, Goodkin HP, Broshek DK, Wintermark M, et al. Quantifying head impacts in collegiate lacrosse. Am J Sports Med. 2016;44(11):2947–56.CrossRefPubMedPubMedCentral Reynolds BB, Patrie J, Henry EJ, Goodkin HP, Broshek DK, Wintermark M, et al. Quantifying head impacts in collegiate lacrosse. Am J Sports Med. 2016;44(11):2947–56.CrossRefPubMedPubMedCentral
26.
Zurück zum Zitat Broglio SP, Martini D, Kasper L, Eckner JT, Kutcher JS. Estimation of head impact exposure in high school football: implications for regulating contact practices. Am J Sports Med. 2013;41(12):2877–84.CrossRefPubMedPubMedCentral Broglio SP, Martini D, Kasper L, Eckner JT, Kutcher JS. Estimation of head impact exposure in high school football: implications for regulating contact practices. Am J Sports Med. 2013;41(12):2877–84.CrossRefPubMedPubMedCentral
27.
Zurück zum Zitat Broglio SP, Sosnoff JJ, Shin S, He X, Alcaraz C, Zimmerman J. Head impacts during high school football: a biomechanical assessment. J Athet Train. 2009;44(4):342–9.CrossRef Broglio SP, Sosnoff JJ, Shin S, He X, Alcaraz C, Zimmerman J. Head impacts during high school football: a biomechanical assessment. J Athet Train. 2009;44(4):342–9.CrossRef
28.
Zurück zum Zitat Martini D, Eckner J, Kutcher J, Broglio S. Subconcussive head impact biomechanics: comparing differing offensive schemes. Med Sci Sports Exerc. 2013;45(4):755.CrossRefPubMedPubMedCentral Martini D, Eckner J, Kutcher J, Broglio S. Subconcussive head impact biomechanics: comparing differing offensive schemes. Med Sci Sports Exerc. 2013;45(4):755.CrossRefPubMedPubMedCentral
29.
Zurück zum Zitat Press JN, Rowson S. Quantifying head impact exposure in collegiate women’s soccer. Clin J Sports Med. 2017;27(2):104–10.CrossRef Press JN, Rowson S. Quantifying head impact exposure in collegiate women’s soccer. Clin J Sports Med. 2017;27(2):104–10.CrossRef
30.
Zurück zum Zitat Cortes N, Lincoln AE, Myer GD, Hepburn L, Higgins M, Putukian M, et al. Video analysis verification of head impact events measured by wearable sensors. Am J Sports Med. 2017;45(10):2379–87.CrossRefPubMed Cortes N, Lincoln AE, Myer GD, Hepburn L, Higgins M, Putukian M, et al. Video analysis verification of head impact events measured by wearable sensors. Am J Sports Med. 2017;45(10):2379–87.CrossRefPubMed
31.
Zurück zum Zitat Patricios J, Fuller GW, Ellenbogen R, Herring S, Kutcher JS, Loosemore M, et al. What are the critical elements of sideline screening that can be used to establish the diagnosis of concussion? A systematic review. Br J Sports Med. 2017;51(11):888–94.PubMed Patricios J, Fuller GW, Ellenbogen R, Herring S, Kutcher JS, Loosemore M, et al. What are the critical elements of sideline screening that can be used to establish the diagnosis of concussion? A systematic review. Br J Sports Med. 2017;51(11):888–94.PubMed
32.
Zurück zum Zitat Broglio SP, Eckner JT, Surma T, Kutcher JS. Post-concussion cognitive declines and symptomatology are not related to concussion biomechanics in high school football players. J Neurotrauma. 2011;28(10):2061–8.CrossRefPubMedPubMedCentral Broglio SP, Eckner JT, Surma T, Kutcher JS. Post-concussion cognitive declines and symptomatology are not related to concussion biomechanics in high school football players. J Neurotrauma. 2011;28(10):2061–8.CrossRefPubMedPubMedCentral
33.
Zurück zum Zitat Guskiewicz KM, Mihalik JP, Shankar V, Marshall SW, Crowell DH, Oliaro SM, et al. Measurement of head impacts in collegiate football players: relationship between head impact biomechanics and acute clinical outcome after concussion. Neurosurgery. 2007;61(6):1244–53.CrossRefPubMed Guskiewicz KM, Mihalik JP, Shankar V, Marshall SW, Crowell DH, Oliaro SM, et al. Measurement of head impacts in collegiate football players: relationship between head impact biomechanics and acute clinical outcome after concussion. Neurosurgery. 2007;61(6):1244–53.CrossRefPubMed
34.
Zurück zum Zitat Gardner AJ, Kohler R, McDonald W, Fuller GW, Tucker R, Makdissi M. The use of sideline video review to facilitate management decisions following head trauma in super rugby. Sports Med Open. 2018;4(1):20.CrossRefPubMedPubMedCentral Gardner AJ, Kohler R, McDonald W, Fuller GW, Tucker R, Makdissi M. The use of sideline video review to facilitate management decisions following head trauma in super rugby. Sports Med Open. 2018;4(1):20.CrossRefPubMedPubMedCentral
35.
Zurück zum Zitat Wilcox BJ, Beckwith JG, Greenwald RM, Raukar NP, Chu JJ, McAllister TW, et al. Biomechanics of head impacts associated with diagnosed concussion in female collegiate ice hockey players. J Biomech. 2015;48(10):2201–4.CrossRefPubMedPubMedCentral Wilcox BJ, Beckwith JG, Greenwald RM, Raukar NP, Chu JJ, McAllister TW, et al. Biomechanics of head impacts associated with diagnosed concussion in female collegiate ice hockey players. J Biomech. 2015;48(10):2201–4.CrossRefPubMedPubMedCentral
36.
Zurück zum Zitat Duma SM, Manoogian SJ, Bussone WR, Brolinson PG, Goforth MW, Donnenwerth JJ, et al. Analysis of real-time head accelerations in collegiate football players. Clin J Sport Med. 2005;15(1):3–8.CrossRefPubMed Duma SM, Manoogian SJ, Bussone WR, Brolinson PG, Goforth MW, Donnenwerth JJ, et al. Analysis of real-time head accelerations in collegiate football players. Clin J Sport Med. 2005;15(1):3–8.CrossRefPubMed
37.
Zurück zum Zitat Brolinson PG, Manoogian S, McNeely D, Goforth M, Greenwald R, Duma S. Analysis of linear head accelerations from collegiate football impacts. Curr Sports Med Rep. 2006;5(1):23–8.CrossRefPubMed Brolinson PG, Manoogian S, McNeely D, Goforth M, Greenwald R, Duma S. Analysis of linear head accelerations from collegiate football impacts. Curr Sports Med Rep. 2006;5(1):23–8.CrossRefPubMed
38.
Zurück zum Zitat Mihalik JP, Bell DR, Marshall SW, Guskiewicz KM. Measurement of head impacts in collegiate football players: an investigation of positional and event-type differences. Neurosurgery. 2007;61(6):1229–35.CrossRefPubMed Mihalik JP, Bell DR, Marshall SW, Guskiewicz KM. Measurement of head impacts in collegiate football players: an investigation of positional and event-type differences. Neurosurgery. 2007;61(6):1229–35.CrossRefPubMed
39.
Zurück zum Zitat Rowson S, Brolinson G, Goforth M, Dietter D, Duma S. Linear and angular head acceleration measurements in collegiate football. J Biomech Eng. 2009;131(6):061016.CrossRefPubMed Rowson S, Brolinson G, Goforth M, Dietter D, Duma S. Linear and angular head acceleration measurements in collegiate football. J Biomech Eng. 2009;131(6):061016.CrossRefPubMed
40.
Zurück zum Zitat Broglio SP, Schnebel B, Sosnoff JJ, Shin S, Feng X, He X, et al. The biomechanical properties of concussions in high school football. Med Sci Sports Exerc. 2010;42(11):2064.CrossRefPubMedPubMedCentral Broglio SP, Schnebel B, Sosnoff JJ, Shin S, Feng X, He X, et al. The biomechanical properties of concussions in high school football. Med Sci Sports Exerc. 2010;42(11):2064.CrossRefPubMedPubMedCentral
41.
Zurück zum Zitat Rowson S, Duma SM, Beckwith JG, Chu JJ, Greenwald RM, Crisco JJ, et al. Rotational head kinematics in football impacts: an injury risk function for concussion. Ann Biomed Eng. 2012;40(1):1–13.CrossRefPubMed Rowson S, Duma SM, Beckwith JG, Chu JJ, Greenwald RM, Crisco JJ, et al. Rotational head kinematics in football impacts: an injury risk function for concussion. Ann Biomed Eng. 2012;40(1):1–13.CrossRefPubMed
42.
Zurück zum Zitat Bazarian JJ, Zhu T, Zhong J, Janigro D, Rozen E, Roberts A, et al. Persistent, long-term cerebral white matter changes after sports-related repetitive head impacts. PLoS One. 2014;9(4):e94734.CrossRefPubMedPubMedCentral Bazarian JJ, Zhu T, Zhong J, Janigro D, Rozen E, Roberts A, et al. Persistent, long-term cerebral white matter changes after sports-related repetitive head impacts. PLoS One. 2014;9(4):e94734.CrossRefPubMedPubMedCentral
43.
Zurück zum Zitat Miyashita T, Diakogeorgiou E, Marrie K, Danaher R. Frequency and location of head impacts in Division I men’s lacrosse players. Athl Train Sports Health Care. 2016;8(5):202–8.CrossRef Miyashita T, Diakogeorgiou E, Marrie K, Danaher R. Frequency and location of head impacts in Division I men’s lacrosse players. Athl Train Sports Health Care. 2016;8(5):202–8.CrossRef
44.
Zurück zum Zitat Miyashita TL, Diakogeorgiou E, Marrie K. Correlation of head impacts to change in Balance Error Scoring System scores in Division I men’s lacrosse players. Sports Health. 2017;9(4):318–23.CrossRefPubMedPubMedCentral Miyashita TL, Diakogeorgiou E, Marrie K. Correlation of head impacts to change in Balance Error Scoring System scores in Division I men’s lacrosse players. Sports Health. 2017;9(4):318–23.CrossRefPubMedPubMedCentral
45.
Zurück zum Zitat O’Day KM, Koehling EM, Vollavanh LR, Bradney D, May JM, Breedlove KM, et al. Comparison of head impact location during games and practices in Division III men’s lacrosse players. Clin Biomech. 2017;43:23–7.CrossRef O’Day KM, Koehling EM, Vollavanh LR, Bradney D, May JM, Breedlove KM, et al. Comparison of head impact location during games and practices in Division III men’s lacrosse players. Clin Biomech. 2017;43:23–7.CrossRef
46.
Zurück zum Zitat Reynolds BB, Patrie J, Henry EJ, Goodkin HP, Broshek DK, Wintermark M, et al. Effects of sex and event type on head impact in collegiate soccer. Orthop J Sports Med. 2017;5(4):2325967117701708.CrossRefPubMedPubMedCentral Reynolds BB, Patrie J, Henry EJ, Goodkin HP, Broshek DK, Wintermark M, et al. Effects of sex and event type on head impact in collegiate soccer. Orthop J Sports Med. 2017;5(4):2325967117701708.CrossRefPubMedPubMedCentral
Metadaten
Titel
Frequency and Magnitude of Game-Related Head Impacts in Male Contact Sports Athletes: A Systematic Review and Meta-Analysis
verfasst von
Jack V. K. Nguyen
James H. Brennan
Biswadev Mitra
Catherine Willmott
Publikationsdatum
07.06.2019
Verlag
Springer International Publishing
Erschienen in
Sports Medicine / Ausgabe 10/2019
Print ISSN: 0112-1642
Elektronische ISSN: 1179-2035
DOI
https://doi.org/10.1007/s40279-019-01135-4

Weitere Artikel der Ausgabe 10/2019

Sports Medicine 10/2019 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.