Year 2022 Vol. 30 No 6

TRAUMATOLOGY AND ORTHOPEDICS

T.A. STUPINA, N.S. MIGALKIN, I.N. MEZENTSEV, A.S. SUDNITSYN

PATHOMORPHOLOGICAL STUDY OF THE COMPONENTS OF THE CHARCOT ANKLE COMPLICATED BY CHRONIC OSTEOMYELITIS AS A BASIS FOR DEVELOPING DIAGNOSTIC HISTOLOGICAL CRITERIA

Federal State Budgetary Institution National Ilizarov Medical Research Centre for Traumatology and Orthopaedics of the RF Ministry of Health, Kurgan,
Russian Federation

Objective. Purpose of this article to study the charateristic features of the structural rearrangement of the main components of the ankle joint in diabetic neuroosteoarthropathy complicated by chronic osteomyelitis using histopathological semi-quantitative assessment of osteomyelitis.
Methods. Analysis of the data of pathohistological studies of the operating material (bone-and-cartilaginous fragments of the ankle with adjacent soft tissues) of 30 patients with the established diagnosis of diabetic neroosteoarthropathy complicated by chronic osteomyelitis. Light microscopy of paraffin-embedded sections using immunohistochemical evaluation of marker of neutrophilic granulocytes CD15 was performed.
Results. The pronounced destruction of the articular cartilage and subchondral bone was revealed in all the patients. The articular cartilage structure disturbance was noted both on the side of the articular surface (synovial pannus, active chondroclasts), and on the side of the subchondral zone (destruction of the basophilic section, the calcified cartilage zone). Fragments of cartilage and bone were distributed in the articular cavity and in the synovium. The synovium was hypertrophied, hypervascularized with inflammatory infiltration. The histopathological semi-quantitative assessment of osteomyelitis and the immunohistochemical detection of CD15-positive neutrophils made it possible to identify signs of the active stage of chronic osteomyelitis in 8 patients, those of subacute course in 16 patients, weakened chronic osteomyelitis (remission) in 6 patients. An increased number of osteoclasts, intense destruction of the subchondral bone plate and a pronounced inflammatory infiltrate with the content of 5 or more neutrophils were observed in patients with an active inflammatory stage of chronic osteomyelitis. A positive correlation was found between the inflammatory stage of chronic osteomyelitis and the severity of inflammatory infiltration and osteonecrosis.
Conclusion. The combination of signs pronounced destruction of the articular cartilage, subchondral bone, hypertrophy of the synovial membrane, bone and cartilaginous fragments in the joint cavity and in the synovial membrane, fragments of bone tissue in the cartilage is a diagnostic histological criterion for the chronic stage of diabetic neroosteoarthropathy. The histopathological semi-quantitative assessment of osteomyelitis and the immunohistochemical determination of CD15 increase the accuracy of the pathological diagnostics of the inflammatory phases of chronic osteomyelitis in diabetic foot syndrome.

Keywords: histology, the ankle (joint), diabetic neroosteoarthropathy, osteomyelitis, diagnostics
p. 562-571 of the original issue
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Address for correspondence:
640014, Russian Federation,
Kurgan, st. M. Ulyanova, 6,
National Medical Research Center
for Traumatology and Orthopedics
Named after Academician G.A. Ilizarov,
tel. +7 905 850-67-89,
e-mail: StupinaSTA@mail.ru,
Stupina Tatyana A.
Information about the authors:
Stupina Tatyana A., MD (Biol), Senior Researcher, Laboratory of Morphology, Ilizarov National Medical Research Centre for Traumatology and Orthopedics, Kurgan, Russian Federation.
http://orcid.org/0000-0003-3434-0372
Migalkin Nikolai S., Researcher. Laboratory of Morphology, Ilizarov National Medical Research Centre for Traumatology and Orthopedics, Kurgan, Russian Federation.
http://orcid.org/0000-0002-7502-5654
Mezentsev Igor N., Pathologist, Ilizarov National Medical Research Centre for Traumatology and Orthopedics, Kurgan, Russian Federation.
http://orcid.org/0000-0002-7598-0707
Sudnitsyn Anatoly S., PhD, Orthopedic Surgion, Ilizarov National Medical Research Centre for Traumatology and Orthopedics, Kurgan, Russian Federation.
http://orcid.org/0000-0002-2602-2457
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