Relationships between morphological indicators of the tibia and soft tissues lesions and some biochemical blood indicators in patients with traumatic osteomyelitis

Authors

DOI:

https://doi.org/10.14739/2310-1237.2021.2.237156

Keywords:

osteomyelitis, tibia, soft tissues, trophic disturbances

Abstract

Aim. Research aim was to find statistical differences of biochemical indicators of blood and morphometric indicators of crural tissue lesion and relationships between them in patients with traumatic osteomyelitis of the tibia with trophic disturbances in extremity.

Material and methods. The work material includes data from 28 patients with traumatic osteomyelitis which was combined with trophic tissue disturbances of different manifestation degree. The levels of procalcitonin, lactate dehydrogenase and acetylcholinesterase of blood serum were estimated. In crural tissues quantitative biochemical, gradual morphometric indicators, frequencies of occurrence of different manifestation degree cases and relationships “clinic – biochemistry – pathomorphology” were defined histologically.

Results. Average values of procalcitonin, lactate dehydrogenase and acetylcholinesterase in patients with traumatic osteomyelitis of the tibia, combined with trophic disturbances in crural tissues, are significantly higher, than average values of these indicators in intact donors. In the majority of the patients with chronic traumatic osteomyelitis in crural tissues pathological changes were found out, which by clinical estimations are considered as trophic disturbances. They represent a combination of discirculatory, ischemic-necro­tic, exsudative, productive-inflammatory, and also reparative processes which in total create a composite picture of complex lesion and can persist for many years. As closest relations, according to values of association coefficient, concerning certain biochemical indicators, can be noted such clinical indicators: “degree of bone fragments non-consolidation” and “severity of trophic disturbances in bone tissue (by clinical estimation)”, concerning defined morphometric indicators – such biochemical indicators: “level of procalcitonin” and “level of lactate dehydrogenase” in blood serum. Among morphometric lesion indicators the closest relations concerning biochemical indicators were revealed: in bones – “the form of the pathological focus of traumatic osteomyelitis” and “presence of sequesters”, in soft tissues – “exsudative inflammation in internal membrane of a focus capsule”.

Conclusions. In chronic traumatic osteomyelitis combined with trophic disturbances of crural tissues, there are relationships between some clinical, biochemical and morphological indicators of the extremity tissues condition. A deviation of metabolism indicators from norm can serve as biochemical markers in definition of severity degree and efficiency of treatment in patients.

Author Biographies

V. V. Hryhorovskyi, SI “Institute of Traumatology and Orthopedics of NAMS of Ukraine”, Kyiv

MD, PhD, DSc, Professor, Pathologist of the Highest Category, Head of the Department of Pathomorphology

S. Mahomedov, SI “Institute of Traumatology and Orthopedics of NAMS of Ukraine”, Kyiv

DSc, Professor, Head of the Department of Biochemistry and Clinical Analyses

M. P. Hrytsai, SI “Institute of Traumatology and Orthopedics of NAMS of Ukraine”, Kyiv

MD, PhD, DSc, Professor, Head of the Department of Bone Purulent Surgery

V. P. Tsokalo, SI “Institute of Traumatology and Orthopedics of NAMS of Ukraine”, Kyiv

MD, PhD, Senior Researcher of the Department of Bone Purulent Surgery

T. A. Kuzub, SI “Institute of Traumatology and Orthopedics of NAMS of Ukraine”, Kyiv

Researcher of the Department of Biochemistry and Clinical Analyses

L. V. Polishchuk, SI “Institute of Traumatology and Orthopedics of NAMS of Ukraine”, Kyiv

Junior Reseacher of the Department of Biochemistry and Clinical Analyses

A. V. Hryhorovska, SI “Institute of Traumatology and Orthopedics of NAMS of Ukraine”, Kyiv

Doctor-pathologist of the Department of Pathomorphology

References

Sato, S. K., & Pimenta-Rodrigues, M. V. (2012). Morphological aspects of osteomyelitis: a mini-review. Journal of Morphological Sciences, 29(1), 16-17.

Grigorovskii, V. V. (2013). Aspekty patomorfologii i nomenklatury v sovremennoi klassifikatsii nespetsificheskikh osteomielitov [Aspects of pathomorphology and nomenclature in the contemporary classification of nonspecific osteomyelitides]. Ortopediya, travmatologiya i protezirovanie, (3), 77-87. [in Russian].

Beck-Broichsitter, B. E., Smeets, R., & Heiland, M. (2015). Current concepts in pathogenesis of acute and chronic osteomyelitis. Current opinion in infectious diseases, 28(3), 240-245. https://doi.org/10.1097/QCO.0000000000000155

Metsemakers, W. J., Morgenstern, M., McNally, M. A., Moriarty, T. F., McFadyen, I., Scarborough, M., Athanasou, N. A., Ochsner, P. E., Kuehl, R., Raschke, M., Borens, O., Xie, Z., Velkes, S., Hungerer, S., Kates, S. L., Zalavras, C., Giannoudis, P. V., Richards, R. G., & Verhofstad, M. (2018). Fracture-related infection: A consensus on definition from an international expert group. Injury, 49(3), 505-510. https://doi.org/10.1016/j.injury.2017.08.040

Govaert, G., Kuehl, R., Atkins, B. L., Trampuz, A., Morgenstern, M., Obremskey, W. T., Verhofstad, M., McNally, M. A., Metsemakers, W. J., & Fracture-Related Infection (FRI) Consensus Group (2020). Diagnosing Fracture-Related Infection: Current Concepts and Recommendations. Journal of orthopaedic trauma, 34(1), 8-17. https://doi.org/10.1097/BOT.0000000000001614

Hryhorovskyi, V. V., Hrytsai, M. P., Tsokalo, V. M., Kolov, H. B., & Hryhorovska, A. V. (2020). Histopatologiia tkanyn homilky ta kliniko-morpholohichni zalezhnosti u hvoryh na travmatychnyi osteomiielit iz trofichnymy rozladamy [Crural tissues histopathology and clinical-morphological correlations in patients with traumatic osteomyelitis, combined with trophic disorders]. Ortopediya, travmatologiya i protezirovanie, (1), 54-65. [in Ukrainian].

Mahomedov, S., Polishchuk, L. V., Kuzub, T. A., Kolov, H. B., & Hordii, A. S. (2016). Metabolizm soedinitel'noi tkani u bol'nykh s gnoinymi oslozhneniyami posle osteosinteza otlomkov dlinnykh kostei [The metabolism of connective tissue in patients with suppurative complications after osteosynthesis of long bone fragments]. Travma, 17(1), 111-115. [in Russian].

Wang, S., Yin, P., Quan, C., Khan, K., Wang, G., Wang, L., Cui, L., Zhang, L., Zhang, L., & Tang, P. (2017). Evaluating the Use of Serum Inflammatory Markers for Preoperative Diagnosis of Infection in Patients with Nonunions. BioMed research international, 2017, 9146317. https://doi.org/10.1155/2017/9146317

Lapin, S. V., Maslyanskiy, A. L., Lazareva, N. M., Vasilyeva, Ye. Yu., & Totolyan, A. A. (2013). Znachenie kolichestvennogo opredeleniya prokal'tsitonina dlya diagnostiki septicheskikh oslozhnenii u bol'nykh s autoimmunnymi revmaticheskimi zabolevaniyami [The value of quantitative analysis of procalcitonine in diagnostics of septic complications in patients with autoimmune rheumatic deseases]. Klinicheskaya laboratornaya diagnostika, 58(1), 28-33. [in Russian].

Bukhanova, D. V., Belov, B. S., Tarasova, G. M., Dilbaryan, A. G. (2017). Prokal'tsitoninovyi test v revmatologii [Procalcitonin testing in rheumatology]. Klinitsist, 11(2), 16-23. [in Russian]. https://doi.org/10.17650/1818-8338-2017-11-2-16-23

Simon, L., Gauvin, F., Amre, D. K., Saint-Louis, P., Lacroix, J. (2004). Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clinical Infectious Diseases, 39(2), 206-217. https://doi.org/10.1086/421997

Puchkova, M. S., Dzeboyeva, T. A., Kaminskaya, L. A. (2015). Funktsional'naya rol' prokal'tsitonina pri razlichnykh zabolevaniyakh [The functional role of procalcitonin by some diseases]. Vestnik nauki i obrazovaniya, 3(5), 163-168. [in Russian].

Mahomedov, S., Kravchenko, O. M., Kolov, G. B., & Shevchuk, A. V. (2018). Prokaltsytonin yak biokhimichnyi marker pry diahnostytsi zapalnykh protsesiv (ohliad literatury) [Procalcitonin as a biochemical marker in the diagnosis of inflammatory processes (literature review)]. Visnyk ortopedii, travmatologii ta protezuvannia, (1), 63-67. [in Ukrainian].

Uzzan, B., Cohen, R., Nicolas, P., Cucherat, M., & Perret, G. Y. (2006). Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: a systematic review and meta-analysis. Critical care medicine, 34(7), 1996-2003. https://doi.org/10.1097/01.CCM.0000226413.54364.36

Sager, R., Kutz, A., Mueller, B., & Schuetz, P. (2017). Procalcitonin-guided diagnosis and antibiotic stewardship revisited. BMC Medicine, 15(1), 15. https://doi.org/10.1186/s12916-017-0795-7

Sato, H., Wada, Y., Hasegawa, E., Nozawa, Y., Nakatsue, T., Ito, T., Kuroda, T., Saeki, T., Umezu, H., Suzuki, Y., Nakano, M., & Narita, I. (2017). Adult-onset Chronic Recurrent Multifocal Osteomyelitis with High Intensity of Muscles Detected by Magnetic Resonance Imaging, Successfully Controlled with Tocilizumab. Internal medicine, 56(17), 2353-2360. https://doi.org/10.2169/internalmedicine.8473-16

Gallagher, K., Armon, K., & Bale, P. (2018). Bone inflammation and fever: an atypical presentation of chronic recurrent multifocal osteomyelitis (CRMO)?. Rheumatology, 57(Suppl 8), key273.034. https://doi.org/10.1093/rheumatology/key273.034

Mathews, D. M., Vance, K. M., McMahon, P. M., Boston, C., & Bolton, M. T. (2018). An Atypical Case of Bartonella henselae Osteomyelitis and Hepatic Disease. Case reports in pediatrics, 2018, 2750275. https://doi.org/10.1155/2018/2750275

Sinhabahu, V.P., Jamison, S. (2020). Unusual presentation of osteomyelitis: A clinical dilemma. Sri Lanka Journal of Child Health, 49(4), 399-400. http://dx.doi.org/10.4038/sljch.v49i4.9276

Butbul-Aviel, Y., Koren, A., Halevy, R., & Sakran, W. (2005). Procalcitonin as a diagnostic aid in osteomyelitis and septic arthritis. Pediatric emergency care, 21(12), 828-832. https://doi.org/10.1097/01.pec.0000190226.12610.24

Hügle, T., Schuetz, P., Mueller, B., Laifer, G., Tyndall, A., Regenass, S., & Daikeler, T. (2008). Serum procalcitonin for discrimination between septic and non-septic arthritis. Clinical and experimental rheumatology, 26(3), 453-456.

Maharajan, K., Patro, D. K., Menon, J., Hariharan, A. P., Parija, S. C., Poduval, M., & Thimmaiah, S. (2013). Serum Procalcitonin is a sensitive and specific marker in the diagnosis of septic arthritis and acute osteomyelitis. Journal of orthopaedic surgery and research, 8, 19. https://doi.org/10.1186/1749-799X-8-19

Shen, C. J., Wu, M. S., Lin, K. H., Lin, W. L., Chen, H. C., Wu, J. Y., Lee, M. C., & Lee, C. C. (2013). The use of procalcitonin in the diagnosis of bone and joint infection: a systemic review and meta-analysis. European journal of clinical microbiology & infectious diseases, 32(6), 807-814. https://doi.org/10.1007/s10096-012-1812-6

Paosong, S., Narongroeknawin, P., Pakchotanon, R., Asavatanabodee, P., & Chaiamnuay, S. (2015). Serum procalcitonin as a diagnostic aid in patients with acute bacterial septic arthritis. International journal of rheumatic diseases, 18(3), 352-359. https://doi.org/10.1111/1756-185X.12496

Zhao, J., Zhang, S., Zhang, L., Dong, X., Li, J., Wang, Y., & Yao, Y. (2017). Serum procalcitonin levels as a diagnostic marker for septic arthritis: A meta-analysis. The American journal of emergency medicine, 35(8), 1166-1171. https://doi.org/10.1016/j.ajem.2017.06.014

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Published

2021-08-20

How to Cite

1.
Hryhorovskyi VV, Mahomedov S, Hrytsai MP, Tsokalo VP, Kuzub TA, Polishchuk LV, Hryhorovska AV. Relationships between morphological indicators of the tibia and soft tissues lesions and some biochemical blood indicators in patients with traumatic osteomyelitis. Pathologia [Internet]. 2021Aug.20 [cited 2024Apr.26];18(2):218-2. Available from: http://pat.zsmu.edu.ua/article/view/237156

Issue

Vol. 18 No. 2 (2021): Pathologia

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Original research

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