Some Morphological and Functional Aspects of Chronic Osteomyelitis in Patients with Neurogenic Foot Deformities

Relevance. Neurological disorders are one the most frequent cause for developing of chronic foot inflammation. Analysis of pathological picture of chronic osteomyelitis in patients with neurogenic foot deformities, including cases of spina bifida, is not adequately addressed.Purpose of the study — to examine morpho-functional aspects of chronic osteomyelitis in patients with multicomponent foot deformities and with spina bifida.Materials and Methods. The present paper is based on the study of 30 patients with multicomponent neurological foot deformities complicated by chronic osteomyelitis who had medical history of spina bifida (myelomeningocele type). Histology was used to examine resected fragments of affected bone tissue, bone sequestration and skin adjacent to osteomyelitis area. Laser doppler flowmetry was used to study capillary cutaneous blood flow on plantar foot surface. Thermal and pain sensitivity was assessed by electric sensimeter in L4, L5, S1 dermatomas on the right and on the left sides.Results. Biopsy skin specimens harvested at osteomyelitis area demonstrated signs of parakeratosis, absence of stratum lucidum, epidermis acanthosis with 25% thickness increase (р = 0,04), 2,2 times increase of density for microvessels of the dermis (р = 0,73Е-4) and increased rate of capillary blood flow at 81,6±14,2% (р = 0,0004), fibrosis and dermis thinning at 19,1% (р = 0,03), 1,37 times increase in bulk density of perspiratory glands (р= 0,04), loss of adipose tissue and degeneration of nerve fibers in the majority of nerve stems of the dermis. Above factors were accompanied by disorders in thermal and pain sensitivity in 100% of cases and in 29% of those sensitivity was missing. Morphological picture of bone tissue in osteomyelitic area was manifested by multiple destruction cavities with pyogenic membrane, granular tissue of varying maturity, combined chronic and acute stages of the process, and by poor restorative bone formation.Conclusion. Disorders or lack of thermal and pain sensitivity in dermatomas L4, L5, S1, of safety sense and motion control, resulting chronic load on atypical foot segments, as well as patho-histological skin alterations contribute to ulcer formation and osteomyelitis in patients with spina bifida and multicomponent foot deformities. Morphological picture of foot bony tissue at osteomyelitic site indicates typical patho-morphological signs of chronic inflammation with poor restorative bone formation

Microscopic Examination of Foot Joints Components in Charcot Arthropathy Complicated by Osteomyelitis

Background. Charcot arthropathy is a serious medical and social problem. Histological studies of foot joints components in Charcot arthropathy complicated by osteomyelitis are few. The purpose of this study was to assess structural changes in the articular cartilage and subchondral bone of the foot joints in Charcot arthropathy complicated by osteomyelitis. Materials and Methods. The bone-cartilage fragments of the ankle, subtalar and metatarsophalangeal joints with the surrounding soft tissues of 20 patients with Charcot arthropathy complicated by chronic osteomyelitis were examined. Part of the material was fixed in neutral formalin. All samples were subjected to standard histological processing. Paraffin sections were stained by Masson’s tricolor method, hematoxylin and eosin. Part of the material was embedded in epoxy resins. Then semi-thin sections were stained with methylene blue and basic fuchsin. Histological preparations were studied by digitizing images under the AxioScope A1 microscope (Carl Zeiss MicroImaging GmbH, Germany).The phase of chronic osteomyelitis inflammation was assessed semi-quantitatively using the histopathological scale by A. Tiemann et al. (2014). Results. In 80% of the patients, the inflammatory phase of chronic osteomyelitis was characterized as active and subacute. In all cases, the areas with full-layer of articular cartilage unweaving, up to the subchondral zone, with cartilaginous tissue fragments rejection into the joint cavity were revealed. Cytoarchitectonics was disrupted. The main part of chondrocytes was in a state of destruction. The articular surface was covered with pannus. There were no basophilic line and the zone of calcified cartilage. The hyaline cartilage was replaced by granulation and/or fibrous tissue. An inflammatory infiltrates was noted in the superficial and deep areas of the cartilage. The impairment of the structure and/or complete absence of the subchondral bone due to the high activity of osteoclasts in the subchondral zone were revealed. An excessive amount of osteoclasts at the border with the articular cartilage was noted, while the signs of reparative bone formation were poorly expressed. Edema and thickening of the vascular walls of the microvasculature were recorded. Conclusion. The microscopic examination of the foot joints in Charcot arthropathy complicated by osteomyelitis revealed structural impairment and/or complete absence of the subchondral bone due to the high activity of osteoclasts in the subchondral zone. Structural changes in the subchondral bone and synovial pannus led to irreversible destruction of articular cartilage and the penetration of infection. These should be taken into account in surgical planning

FEATURES OF THE PATHOMORPHOLOGICAL DIAGNOSIS OF MICROCRYSTALLINE ARTHROPATHIES IN THE PRACTICE OF SURGICAL MATERIAL EXAMINATION

The development of microcrystalline arthritides is most frequently associated with the formation of monosodium urate (MSU) and calcium pyrophosphate (CPP) crystals. Their identification is of crucial importance in recognizing these diseases. Objective: to determine the possibilities of histological techniques in identifying MSU and CPP crystals and to evaluate the effectiveness of the techniques. Subjects and methods. Twenty-four tissue blocks (fragments of the affected areas of the elbow joint, the interphalangeal joint of the index finger, and hip joint) from 7 patients were examined. Paraffin sections were stained with a 0.5% alcohol solution of eosin, as well as with hematoxylin and eosin. Tissue specimens were examined and digitized using an AxioScope.A1 stereo microscope with Zenblue software (Carl Zeiss MicroImaging GmbH, Germany). Results and discussion. When staining the tissue sections with hematoxylin and eosin, microcrystals were not visualized; the major portions of MSU crystals was dissolved during fixation and staining, whereas CPP crystals were masked with hematoxylin as focal basophilic aggregates. The staining technique with an alcohol solution of eosin and short formalin fixation (within 12 hours) made it possible to avoid dissolution of MSU crystals and to visualize both MSU and CPP crystals, and to determine their shape and color. Conclusion. Light microscopy of the tissue sections stained with an alcohol solution of eosin along with short formalin fixation is a reliable method to differentiate MSU and CPP crystals. In patients undergoing endoprosthetic replacement, the significance of this technique for the pathomorphological study of surgical material consists in assessing inflammatory activity and in eliminating a disease, such as microcrystalline arthropathy