Zeitschrift für Orthopädie und Unfallchirurgie, 2013
Fractures of the medial humeral epicondyle represent approximately 10 % of all paediatric elbow f... more Fractures of the medial humeral epicondyle represent approximately 10 % of all paediatric elbow fractures. material and methods: Surgically treated paediatric fractures of the medial humeral epicondyle were analysed retrospectively for their epidemiological, clinical and surgical parameters. Re-evaluation included clinical function, satisfaction, pain level and MAYO elbow performance score (MEPS). 22 children could be included. A re-evaluation of 91 % of our patients after a follow-up of ∅ 4 years (range: 1-9 years; median: 4 years) after initial surgery was possible. Subjective outcome and objective function were good with moderate limitations. 85 % of our patients showed good to excellent results in the MEPS. Regarding our own good clinical results and potentially lower rates of pseudarthrosis - in comparison to conservatively treated patients - by trend we recommend internal fixation in paediatric fractures of the medial humeral epicondyle. However, operative or conservative trea...
Fragestellung: Die subtalare Distraktionsarthrodese kommt überwiegend nach intraartikulärer Kalka... more Fragestellung: Die subtalare Distraktionsarthrodese kommt überwiegend nach intraartikulärer Kalkaneusfraktur mit symptomatischer subtalarer Arthrose und Fehlstellung zum Einsatz (>90%); seltenere Indikationen sind die primäre Arthrose des Subtalargelenks, die Anschlussarthrose[zum vollständigen Text gelangen Sie über die oben angegebene URL]
Fragestellung: Traumatische Weichteilschäden und deren Folgezustände bestimmen wesentlich die Pro... more Fragestellung: Traumatische Weichteilschäden und deren Folgezustände bestimmen wesentlich die Prognose komplexer Verletzungen. Bei zusätzlich vorliegendem Diabetes mellitus Typ II und dadurch bedingten Begleitpathologien wie Angio- und Neuropathie wird von einer verzögerten Regeneration[for full text, please go to the a.m. URL]
Fragestellung: Im klinischen Alltag werden überwiegend die Klassifikationen nach Tossy oder nach ... more Fragestellung: Im klinischen Alltag werden überwiegend die Klassifikationen nach Tossy oder nach Rockwood und Matsen für die Eineilung des Schweregrades von ACG Sprengungen und als Entscheidungshilfe ob eine konservative oder eine operative Behandlung indiziert ist herangezogen. Über [for full text, please go to the a.m. URL]
Insufficiency of skeletal muscle regeneration often impedes the healing process with functional d... more Insufficiency of skeletal muscle regeneration often impedes the healing process with functional deficiencies and scar formation. We therefore tested the hematopoietic growth factor G-CSF with respect to its efficacy to improve functional muscle regeneration following blunt skeletal muscle injury in Wistar rats. After standardized open crush injury to the left soleus muscle, animals received daily G-CSF (20 μg/kg ip) or vehicle solution (n = 21 per group). Sham-operated animals without muscle injury served as controls (n = 15). After in vivo assessment of the fast twitch and tetanic contraction capacity of the soleus muscles at days 4, 7 and 14 post-injury, sampling of muscle tissue served for analysis of muscle tissue cell proliferation (bromodeoxyuridine (BrdU)-immunohistochemistry) and cell apoptosis (TUNEL-analysis). Muscle strength analysis revealed recovery of contraction forces to 28 ± 2, 35 ± 2, and 54 ± 3 % (twitch force) and to 21 ± 3, 25 ± 2 and 39 ± 2 % (tetanic force) wi...
Proximal humerus fractures are one of the most common fractures in elderly patients. In the treat... more Proximal humerus fractures are one of the most common fractures in elderly patients. In the treatment of complex proximal humerus fractures, primary hemiarthroplasty is still discussed controversially. The present study was undertaken to evaluate the results of primary hemiarthroplasty in the treatment of proximal humerus fractures with a modular prosthesis (EPOCA, Fa. Argomedical, Gifhorn, Germany). A prospective study of 24 patients with complex humerus fracture (NEER: IV/4, V/4, VI/4, and head split fracture) was performed from August 2000 to December 2002. Mean age was 75.6 years (range: 52-92); 18 patients were seen for follow-up after 0.5 and 1 year, respectively. The Constant-Murley score (max. 100 points) and the UCLA Rating System (max. 35 points) were calculated for functional assessment of the operated shoulder. Fifteen patients (83%) were pain free 1 year after the operation. The Constant-Murley score improved from 52 (+/-17) to 56 (+/-18) at the second follow-up after 1 year. On the contralateral side a score of 86 (+/-10) was assessed (p<0.05 vs operated side). Correspondingly, shoulder function according to the UCLA Rating System improved [25 (+/-4); 27 (+/-5)]. Osteoporotic bone of older patients often may not permit stable internal fixation of complex proximal humerus fractures. In these situations primary hemiarthroplasty is the treatment of choice.
Ischamie und Reperfusion der Skelettmuskulatur fuhren zu charakteristischen Storungen der Mikrozi... more Ischamie und Reperfusion der Skelettmuskulatur fuhren zu charakteristischen Storungen der Mikrozirkulation, welche durch IPC deutlich reduziert werden konnen. Postischamische Zellapoptose und Nociception hingegen bleiben von IPC unbeeinflusst, was -im Vergleich zu postischamischen Mikrozirkulationsstorungen- auf unterschiedliche zugrundeliegende Pathomechanismen hinweist, die aktuell aufgeklart werden.
Using high resolution multi-fluorescence microscopy, we herein report on the efficiency of the se... more Using high resolution multi-fluorescence microscopy, we herein report on the efficiency of the selective cyclooxygenase (C0X)-2 inhibitor parecoxib to improve compromised perfusion of traumatized skeletal muscle tissue and to prevent secondary tissue damage. Closed soft tissue trauma of the left hind limb was induced in pentobarbital-anesthetized rats that had received either parecoxib sodium (lOmg/kg bw iv; parecoxib, n = 7) or equal volumes of saline (saline, n = 7). Animals without trauma served as controls (sham, n = 7). As assessed by Western blot analysis, soft tissue injury caused a progressive upregulation of COX-2 protein expression at 4 h- 12 h with recovery at 18 h after trauma. Treatment with parecoxib caused an almost complete restoration of microcirculatory impairment within the injured muscle over 18 h after trauma, as given by values of nutritive perfusion (434 ± 15 cm/cm2), NADH levels (73 ±2 aU) and inflammatory cell interaction (leukocytes: 184 ± 36 n/mm2; platelets: 1.0 ± 0.1 n/mm2) not different to that found in non-injured muscle tissue of controls. In contrast, at 18 h after trauma skeletal muscle in saline-treated animals revealed still marked perfusion failure (296 ± 30 cm/cm2) with tissue hypoxia (NADH 101 ± 4 alJ) and enhanced endothelial interaction of both leukocytes (854 ± 74 n/mm2) and platelets (2.3 ± 0.5 n/mm2). Treatment with parecoxib after skeletal muscle soft tissue trauma is highly effective in restoration of disturbed microcirculation. Moreover, reduced inflammatory cell response helps to prevent from leukocyte/platelet-dependent secondary tissue injury. Thus, selective COX-2 inhibitors are recommendable to improve performance and to promote healing in case of closed soft tissue injury.
Posttraumatic arthritis of the joint components of the hind foot is typically linked with hind fo... more Posttraumatic arthritis of the joint components of the hind foot is typically linked with hind foot deformity and involvement of the neighbouring joint. The principal goals of any hind foot reconstruction are to achieve a quasi-anatomical reconstruction of the geometry and a stable and plantigrade foot position as a prerequisite for acceptable gait function, and an overall satisfactory result for the patient. Profound knowledge of the functions of the ankle-hind foot complex is the basis for the development of a valid therapeutic strategy. Any surgical reconstruction has to consider previous interventions, local soft tissue conditions, neurovascular status, and the components of deformity and degree of arthritic destruction at the corresponding joint levels. In general, an arthrodesis of any hind foot joint, as a key element in hind foot reconstruction, will be successful if correction of the underlying deformity is also adequately addressed.
Proximal segmental tibia fractures are rare injuries. Concomitant soft tissue injury, additional ... more Proximal segmental tibia fractures are rare injuries. Concomitant soft tissue injury, additional articular involvement and ligament injuries, secondary displacement, infection and pseudarthrosis present high demands for the implant and the surgeon. This clinical study was designed to clarify whether Tibia-LISS is a suitable implant for this type of fracture. From January 2002 to June 2005, 24 consecutive patients with proximal segmental tibia fractures were evaluated prospectively. All fractures were treated with Tibia-LISS. Follow-up examination was every 4 weeks until fracture healing. The final follow-up examination was at least 1 year after surgery and the average time was 23 months. Of the 24 patients, 23 could be considered for the follow up examination. On average 3.4 operations per patient were necessary, in 19 patients the fractures (82.6%) healed within 6 months after surgery, 2 deep-seated infections and 5 postoperative misalignments occurred. No patient suffered from secondary loss of reduction but 11 patients (47.8%) suffered from a complicated healing process. Tibia-LISS is a suitable implant for the treatment of proximal segmental tibia fractures with an acceptable rate of complications.
Insufficient skeletal muscle regeneration after injury often impedes the healing process and is a... more Insufficient skeletal muscle regeneration after injury often impedes the healing process and is accompanied by functional deficiencies or pain. The aim of our study was to provide evidence that vitamin D improves muscle healing after muscle injury. Therefore, we used male rats and induced an injury of the soleus muscle. After crush injury, animals received either 8.3 mg/kg (332,000 IU/kg) body weight vitamin D or vehicle solution, s.c. After assessment of muscle force at days 1, 4, 14, and 42 after injury, sampling of muscle tissue served for analysis of proliferation, apoptosis, satellite cells, and prolyl-4-hydroxylase-β expression. Vitamin D application caused a significant increase in cell proliferation and a significant inhibition of apoptosis at day 4 after injury compared to control animals. The numbers of satellite cells were not influenced by the vitamin D application, but there was an increase in prolyl-4-hydroxylase-β expression, indicative of increased extracellular matrix proteins. This cellular turnover resulted in a faster recovery of contraction forces at day 42 in the vitamin D group. Current data support the hypothesis that vitamin D promotes the regenerative process in injured muscle. Thus, vitamin D treatment may represent a promising therapy to optimize recovery after injury.
The therapy of combined peripheral nerve-muscle injuries is of high clinical relevance in trauma ... more The therapy of combined peripheral nerve-muscle injuries is of high clinical relevance in trauma surgery. Nerve injuries lead to atrophy of the innervated uninjured muscle. Until now there are no studies addressing regeneration of the muscle after a combined nerve-muscle injury. Therefore we have developed a rat model to study the complex pathophysiology of such injuries. For this purpose, we performed a standardized open blunt crush injury to the left soleus muscle of 72 male Wistar rats. We classified the simultaneous ipsilateral trauma of the N. ischadicus according to the degree of severity (sham (s), contusion (c), dissection (d)). Analysis of fast twitch and tetanic contraction capacities of the soleus muscle allowed the assessment of the functional recovery of muscle tissue. Nerve damage was analyzed by measurement of nerve conduction velocity (NCV) and of mechanical allodynia using Von Frey monofilaments. For the assessment of local tissue integrity and cell proliferation we used electron microscopy, BrdU immunohistochemistry and TUNEL analysis of muscle and nerve tissue on day 1, 7, 14 and 42 after trauma. Contraction force analysis revealed significantly lower values of relative muscle strength (given in % to the contralateral non-injured extremity) according to the degree of nerve lesion after 1, 7, 14 and 42 days (fast twitch [%] s-1: 8±1 ;s-7: 44 ± 1, s-14: 66 ± 3, s-42: 7 5±2v ersus c-1: 3±1 ;c-7: 31 ± 2, c-14: 24 ± 2, c-42: 5 9±2v ersus d-1: 2±0 ;d-7: 21 ± 4, d-14: 21 ± 2, d-42 :9±2 ; tetanic [%] s-1: 4±2 ; s-7: 32 ± 1, s-14: 56 ± 1, s-42: 5 9±2v ersus c-1: 4±1 ;c-7: 18 ± 2, c-14: 16 ± 1, c-42: 4 6±3v ersusd-1: 2 ± 1; d-7: 19 ± 2; d-14: 14 ± 1; d-42: 8 ± 2). NCV of animals of the contusion group was initially decreased by 50 % when compared with the NCV of sham animals, partially recovered from day 14 onward, but did not reach physiological values at the end point of the study (c-42: 64 % of s-42). Concomitantly, allodynia was most prominent in group c (10g Frey-filament [%] s-14 :8±4 ;c-14: 21 ± 3; d-14: 7 ± 4). In addition, the more severe the nerve lesion was, the lower was the number of proliferating BrdU-positive satellite cells, endothelial cells and non-endothelial cells in skeletal muscle tissue. Taken together we found a significant dysfunction of skeletal muscle after blunt crush injury depending to the degree of simultaneous peripheral nerve injury. The regeneration of the muscle upon combined nerve-muscle injury is distinctively slowed in comparison to that after an isolated muscle trauma. Our model of combined nerve-muscle injury in rats permits the standardized investigation of basic pathomechanisms and assessment of new therapy approaches.
Zeitschrift für Orthopädie und Unfallchirurgie, 2013
Fractures of the medial humeral epicondyle represent approximately 10 % of all paediatric elbow f... more Fractures of the medial humeral epicondyle represent approximately 10 % of all paediatric elbow fractures. material and methods: Surgically treated paediatric fractures of the medial humeral epicondyle were analysed retrospectively for their epidemiological, clinical and surgical parameters. Re-evaluation included clinical function, satisfaction, pain level and MAYO elbow performance score (MEPS). 22 children could be included. A re-evaluation of 91 % of our patients after a follow-up of ∅ 4 years (range: 1-9 years; median: 4 years) after initial surgery was possible. Subjective outcome and objective function were good with moderate limitations. 85 % of our patients showed good to excellent results in the MEPS. Regarding our own good clinical results and potentially lower rates of pseudarthrosis - in comparison to conservatively treated patients - by trend we recommend internal fixation in paediatric fractures of the medial humeral epicondyle. However, operative or conservative trea...
Fragestellung: Die subtalare Distraktionsarthrodese kommt überwiegend nach intraartikulärer Kalka... more Fragestellung: Die subtalare Distraktionsarthrodese kommt überwiegend nach intraartikulärer Kalkaneusfraktur mit symptomatischer subtalarer Arthrose und Fehlstellung zum Einsatz (>90%); seltenere Indikationen sind die primäre Arthrose des Subtalargelenks, die Anschlussarthrose[zum vollständigen Text gelangen Sie über die oben angegebene URL]
Fragestellung: Traumatische Weichteilschäden und deren Folgezustände bestimmen wesentlich die Pro... more Fragestellung: Traumatische Weichteilschäden und deren Folgezustände bestimmen wesentlich die Prognose komplexer Verletzungen. Bei zusätzlich vorliegendem Diabetes mellitus Typ II und dadurch bedingten Begleitpathologien wie Angio- und Neuropathie wird von einer verzögerten Regeneration[for full text, please go to the a.m. URL]
Fragestellung: Im klinischen Alltag werden überwiegend die Klassifikationen nach Tossy oder nach ... more Fragestellung: Im klinischen Alltag werden überwiegend die Klassifikationen nach Tossy oder nach Rockwood und Matsen für die Eineilung des Schweregrades von ACG Sprengungen und als Entscheidungshilfe ob eine konservative oder eine operative Behandlung indiziert ist herangezogen. Über [for full text, please go to the a.m. URL]
Insufficiency of skeletal muscle regeneration often impedes the healing process with functional d... more Insufficiency of skeletal muscle regeneration often impedes the healing process with functional deficiencies and scar formation. We therefore tested the hematopoietic growth factor G-CSF with respect to its efficacy to improve functional muscle regeneration following blunt skeletal muscle injury in Wistar rats. After standardized open crush injury to the left soleus muscle, animals received daily G-CSF (20 μg/kg ip) or vehicle solution (n = 21 per group). Sham-operated animals without muscle injury served as controls (n = 15). After in vivo assessment of the fast twitch and tetanic contraction capacity of the soleus muscles at days 4, 7 and 14 post-injury, sampling of muscle tissue served for analysis of muscle tissue cell proliferation (bromodeoxyuridine (BrdU)-immunohistochemistry) and cell apoptosis (TUNEL-analysis). Muscle strength analysis revealed recovery of contraction forces to 28 ± 2, 35 ± 2, and 54 ± 3 % (twitch force) and to 21 ± 3, 25 ± 2 and 39 ± 2 % (tetanic force) wi...
Proximal humerus fractures are one of the most common fractures in elderly patients. In the treat... more Proximal humerus fractures are one of the most common fractures in elderly patients. In the treatment of complex proximal humerus fractures, primary hemiarthroplasty is still discussed controversially. The present study was undertaken to evaluate the results of primary hemiarthroplasty in the treatment of proximal humerus fractures with a modular prosthesis (EPOCA, Fa. Argomedical, Gifhorn, Germany). A prospective study of 24 patients with complex humerus fracture (NEER: IV/4, V/4, VI/4, and head split fracture) was performed from August 2000 to December 2002. Mean age was 75.6 years (range: 52-92); 18 patients were seen for follow-up after 0.5 and 1 year, respectively. The Constant-Murley score (max. 100 points) and the UCLA Rating System (max. 35 points) were calculated for functional assessment of the operated shoulder. Fifteen patients (83%) were pain free 1 year after the operation. The Constant-Murley score improved from 52 (+/-17) to 56 (+/-18) at the second follow-up after 1 year. On the contralateral side a score of 86 (+/-10) was assessed (p<0.05 vs operated side). Correspondingly, shoulder function according to the UCLA Rating System improved [25 (+/-4); 27 (+/-5)]. Osteoporotic bone of older patients often may not permit stable internal fixation of complex proximal humerus fractures. In these situations primary hemiarthroplasty is the treatment of choice.
Ischamie und Reperfusion der Skelettmuskulatur fuhren zu charakteristischen Storungen der Mikrozi... more Ischamie und Reperfusion der Skelettmuskulatur fuhren zu charakteristischen Storungen der Mikrozirkulation, welche durch IPC deutlich reduziert werden konnen. Postischamische Zellapoptose und Nociception hingegen bleiben von IPC unbeeinflusst, was -im Vergleich zu postischamischen Mikrozirkulationsstorungen- auf unterschiedliche zugrundeliegende Pathomechanismen hinweist, die aktuell aufgeklart werden.
Using high resolution multi-fluorescence microscopy, we herein report on the efficiency of the se... more Using high resolution multi-fluorescence microscopy, we herein report on the efficiency of the selective cyclooxygenase (C0X)-2 inhibitor parecoxib to improve compromised perfusion of traumatized skeletal muscle tissue and to prevent secondary tissue damage. Closed soft tissue trauma of the left hind limb was induced in pentobarbital-anesthetized rats that had received either parecoxib sodium (lOmg/kg bw iv; parecoxib, n = 7) or equal volumes of saline (saline, n = 7). Animals without trauma served as controls (sham, n = 7). As assessed by Western blot analysis, soft tissue injury caused a progressive upregulation of COX-2 protein expression at 4 h- 12 h with recovery at 18 h after trauma. Treatment with parecoxib caused an almost complete restoration of microcirculatory impairment within the injured muscle over 18 h after trauma, as given by values of nutritive perfusion (434 ± 15 cm/cm2), NADH levels (73 ±2 aU) and inflammatory cell interaction (leukocytes: 184 ± 36 n/mm2; platelets: 1.0 ± 0.1 n/mm2) not different to that found in non-injured muscle tissue of controls. In contrast, at 18 h after trauma skeletal muscle in saline-treated animals revealed still marked perfusion failure (296 ± 30 cm/cm2) with tissue hypoxia (NADH 101 ± 4 alJ) and enhanced endothelial interaction of both leukocytes (854 ± 74 n/mm2) and platelets (2.3 ± 0.5 n/mm2). Treatment with parecoxib after skeletal muscle soft tissue trauma is highly effective in restoration of disturbed microcirculation. Moreover, reduced inflammatory cell response helps to prevent from leukocyte/platelet-dependent secondary tissue injury. Thus, selective COX-2 inhibitors are recommendable to improve performance and to promote healing in case of closed soft tissue injury.
Posttraumatic arthritis of the joint components of the hind foot is typically linked with hind fo... more Posttraumatic arthritis of the joint components of the hind foot is typically linked with hind foot deformity and involvement of the neighbouring joint. The principal goals of any hind foot reconstruction are to achieve a quasi-anatomical reconstruction of the geometry and a stable and plantigrade foot position as a prerequisite for acceptable gait function, and an overall satisfactory result for the patient. Profound knowledge of the functions of the ankle-hind foot complex is the basis for the development of a valid therapeutic strategy. Any surgical reconstruction has to consider previous interventions, local soft tissue conditions, neurovascular status, and the components of deformity and degree of arthritic destruction at the corresponding joint levels. In general, an arthrodesis of any hind foot joint, as a key element in hind foot reconstruction, will be successful if correction of the underlying deformity is also adequately addressed.
Proximal segmental tibia fractures are rare injuries. Concomitant soft tissue injury, additional ... more Proximal segmental tibia fractures are rare injuries. Concomitant soft tissue injury, additional articular involvement and ligament injuries, secondary displacement, infection and pseudarthrosis present high demands for the implant and the surgeon. This clinical study was designed to clarify whether Tibia-LISS is a suitable implant for this type of fracture. From January 2002 to June 2005, 24 consecutive patients with proximal segmental tibia fractures were evaluated prospectively. All fractures were treated with Tibia-LISS. Follow-up examination was every 4 weeks until fracture healing. The final follow-up examination was at least 1 year after surgery and the average time was 23 months. Of the 24 patients, 23 could be considered for the follow up examination. On average 3.4 operations per patient were necessary, in 19 patients the fractures (82.6%) healed within 6 months after surgery, 2 deep-seated infections and 5 postoperative misalignments occurred. No patient suffered from secondary loss of reduction but 11 patients (47.8%) suffered from a complicated healing process. Tibia-LISS is a suitable implant for the treatment of proximal segmental tibia fractures with an acceptable rate of complications.
Insufficient skeletal muscle regeneration after injury often impedes the healing process and is a... more Insufficient skeletal muscle regeneration after injury often impedes the healing process and is accompanied by functional deficiencies or pain. The aim of our study was to provide evidence that vitamin D improves muscle healing after muscle injury. Therefore, we used male rats and induced an injury of the soleus muscle. After crush injury, animals received either 8.3 mg/kg (332,000 IU/kg) body weight vitamin D or vehicle solution, s.c. After assessment of muscle force at days 1, 4, 14, and 42 after injury, sampling of muscle tissue served for analysis of proliferation, apoptosis, satellite cells, and prolyl-4-hydroxylase-β expression. Vitamin D application caused a significant increase in cell proliferation and a significant inhibition of apoptosis at day 4 after injury compared to control animals. The numbers of satellite cells were not influenced by the vitamin D application, but there was an increase in prolyl-4-hydroxylase-β expression, indicative of increased extracellular matrix proteins. This cellular turnover resulted in a faster recovery of contraction forces at day 42 in the vitamin D group. Current data support the hypothesis that vitamin D promotes the regenerative process in injured muscle. Thus, vitamin D treatment may represent a promising therapy to optimize recovery after injury.
The therapy of combined peripheral nerve-muscle injuries is of high clinical relevance in trauma ... more The therapy of combined peripheral nerve-muscle injuries is of high clinical relevance in trauma surgery. Nerve injuries lead to atrophy of the innervated uninjured muscle. Until now there are no studies addressing regeneration of the muscle after a combined nerve-muscle injury. Therefore we have developed a rat model to study the complex pathophysiology of such injuries. For this purpose, we performed a standardized open blunt crush injury to the left soleus muscle of 72 male Wistar rats. We classified the simultaneous ipsilateral trauma of the N. ischadicus according to the degree of severity (sham (s), contusion (c), dissection (d)). Analysis of fast twitch and tetanic contraction capacities of the soleus muscle allowed the assessment of the functional recovery of muscle tissue. Nerve damage was analyzed by measurement of nerve conduction velocity (NCV) and of mechanical allodynia using Von Frey monofilaments. For the assessment of local tissue integrity and cell proliferation we used electron microscopy, BrdU immunohistochemistry and TUNEL analysis of muscle and nerve tissue on day 1, 7, 14 and 42 after trauma. Contraction force analysis revealed significantly lower values of relative muscle strength (given in % to the contralateral non-injured extremity) according to the degree of nerve lesion after 1, 7, 14 and 42 days (fast twitch [%] s-1: 8±1 ;s-7: 44 ± 1, s-14: 66 ± 3, s-42: 7 5±2v ersus c-1: 3±1 ;c-7: 31 ± 2, c-14: 24 ± 2, c-42: 5 9±2v ersus d-1: 2±0 ;d-7: 21 ± 4, d-14: 21 ± 2, d-42 :9±2 ; tetanic [%] s-1: 4±2 ; s-7: 32 ± 1, s-14: 56 ± 1, s-42: 5 9±2v ersus c-1: 4±1 ;c-7: 18 ± 2, c-14: 16 ± 1, c-42: 4 6±3v ersusd-1: 2 ± 1; d-7: 19 ± 2; d-14: 14 ± 1; d-42: 8 ± 2). NCV of animals of the contusion group was initially decreased by 50 % when compared with the NCV of sham animals, partially recovered from day 14 onward, but did not reach physiological values at the end point of the study (c-42: 64 % of s-42). Concomitantly, allodynia was most prominent in group c (10g Frey-filament [%] s-14 :8±4 ;c-14: 21 ± 3; d-14: 7 ± 4). In addition, the more severe the nerve lesion was, the lower was the number of proliferating BrdU-positive satellite cells, endothelial cells and non-endothelial cells in skeletal muscle tissue. Taken together we found a significant dysfunction of skeletal muscle after blunt crush injury depending to the degree of simultaneous peripheral nerve injury. The regeneration of the muscle upon combined nerve-muscle injury is distinctively slowed in comparison to that after an isolated muscle trauma. Our model of combined nerve-muscle injury in rats permits the standardized investigation of basic pathomechanisms and assessment of new therapy approaches.
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