Radiographic and histological parallels of stages of chronic osteomyelitis

Abstract

Hip joint replacement in trauma and orthopedic practice has become a standard surgery for adult patients. Among all complications, which have negative effect on the outcome of joint replacement, the special place is taken by a deep infection of the surgical wound, chronic osteomyelitis. Timely diagnostics and revealing the character of the infection process play an enormous role in determining amount of surgical intervention. In recent years it has been proposed to include morphologic confirmation of the stage and extension of the infection process in diagnostic algorithm of osteomyelitis. In 58 patients with chronic osteomyelitis peculiarities of structure of the proximal femur were studied by method of multisection computer tomography and histologically. Radiographic and morphological properties of acute, sub-acute course of osteomyelitis and bone condition during remission were revealed. Visual differences and morphological parallels of anatomy and architectonics of bone during acute stage and remission were discovered. The head of the femur (or a fragment thereof), the cervical stump had uneven contours, contained resorption zones with density in the negative spectrum of the Hounsfield scale, the density of the acetabular roof, the area of the large trochanter was significantly reduced in the period of exacerbation and in the subacute phase. Cortical plate had a different thickness and density and was below normal values. Cortical plate defects of various lengths were detected in the presence of fistulas. The specified spongy bone of the femoral head was determined histologically with almost complete destruction of the articular cartilage, thinning of the subchondral bone plate, necrosis of the bone trabeculae, substitution of the intertubular space with necrotic detritus fields, clusters of purulent exudate, granulation tissue, fibrosing fields. In the subacute form, a large number of segment-nucleated leukocytes were determined in the intertrackal spaces of a spongy portion of the examined material. The phenomena of osteoporosis in the acetabular region and the preserved part of the femur remained, no fresh destructive changes were detected in the period of remission. In a number of cases, small, loose, caseless granulomas of lymphocytic and macrophagal composition, parts of reparative bone formation on the surface of partially necrotic bone trabeculae with a layer of newly formed osteoid and a layer of osteoblasts on the endosteal surface of the bone trabecular complex were morphologically determined.

Keywords

endoprosthetics / suppuration of the postoperative wound / chronic osteomyelitis / caseless granulomas / broken spongy bone / subchondral bone plate / reparative bone formation / computer tomography / histology

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