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

Cover Page

Abstract

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.

About the authors

A. S. Sudnitsyn

Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopedics

Email: fake@neicon.ru

Anatoly S. Sudnitsyn — cand. Sci. (Med.), researcher, Laboratory of Purulent Osteology

Kurgan Russian Federation

E. N. Shchurova

Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopedics

Author for correspondence.
Email: elena.shurova@mail.ru

Elena N. Shchurova — Dr. Sci. (Biol.), leading researcher, Laboratory of Deformity Correction and Limb Lengthening

Kurgan Russian Federation

T. N. Varsegova

Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopedics

Email: fake@neicon.ru

Tatyana N. Varsegova — cand. Sci. (Biol.), senior researcher, Laboratory of Morphology

Kurgan Russian Federation

T. A. Stupina

Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopedics

Email: fake@neicon.ru

Tatyana A. Stupina — Dr. Sci. (Biol.), leading researcher, Laboratory of Morphology

Kurgan Russian Federation

N. S. Migalkin

Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopedics

Email: fake@neicon.ru

Nikolay S. Migalkin — researcher, Laboratory of Morphology

Kurgan Russian Federation

References

  1. Ардашев И.П., Гатин В.Р., Ардашева Е.И., Стариков Т.Н., Носков В.П., Веретельникова И.Ю., Петрова О.И., Каткова М.А. Отдаленные результаты консервативного лечения остеомиелита позвоночника. Вестник новых медицинских технологий.2014;21(3):108-111.
  2. Wirbel R., Hermans K. Surgical treatment of chronic osteomyelitis in children admitted from developing countries. Afr J Paediatr Surg. 2014;11(4):297-303. doi: 10.4103/0189-6725.143133.
  3. Новомлинский В.В., Малкина Н.А., Андреев А.А., Глухов А.А., Микулич Е.В. Современные аспекты диагностики и лечения остеомиелита. Обзор литературы. Современные проблемы науки и образования. 2016;5. Режим доступа: http://www.science-education.ru/ru/article/view?id=25326.
  4. Jerzy K., Francis H. Chronic osteomyelitis — bacterial flora, antibiotic sensitivity and treatment challenges. Open Orthop J. 2018;12:153-163. doi: 10.2174/1874325001812010153.
  5. Roy M., Somerson J.S., Kerr K.G., Conroy J.L. Pathophysiology and pathogenesis of osteomyelitis. ed. M.S. Baptista, j.P. Tardivo. Intechopen, 2012. ch. 1. P. 3-26. doi: 10.5772/1264. Available from: https://www.intechopen.com/books/osteomyelitis.
  6. Ertugrul B.M., Lipsky B.A. Osteomyelitis or charcot neuro-osteoarthropathy? Differentiating these disorders in diabetic patients with a foot problem. Diabet Foot Ankle. 2013;4:1-8. doi: 10.3402/dfa.v4i0.21855.
  7. Grimes J.S. Jr. Infections of the foot: osteomyelitis. Mann’s surgery of the foot and ankle. 9th edition. ed. M.J. Coughlin, C. Saltzman, R.B. Anderson. Philadelphia: Saunders, 2014. Vol. 1. ch. 15. P. 757-759.
  8. Kliushin N.M., Sudnitsyn A.S., Subramanyam K.N., George J. Management of neurologic deformity of the ankle and foot with concurrent osteomyelitis with the Ilizarov method. Foot Ankle Int. 2018; 39(2):226-235. doi: 10.1177/1071100717739396.
  9. Biedermann R. Orthopedic management of spina bifida. Orthopade. 2014;43(7):603-610. doi: 10.1007/s00132-013-2215-9.
  10. Kelley S.P., Bache C.E., Graham H.K., Donnan L.T. Limb reconstruction using circular frames in children and adolescents with spina bifida. J Bone Joint Surg Br. 2010;92(7):1017-1022. doi: 10.1302/0301-620x.92B7.22965.
  11. Maynard M.J., Weiner L.S, Burke S.W. Neuropathic foot ulceration in patients with myelodysplasia. J Pediatr Orthop. 1992;12(6):786-788.
  12. Srivastava V.K. Wound healing in trophic ulcers in spina bifida patients. J Neurosurg. 1995;82(1):40-43.
  13. Ebid A.A., El-Kafy E.M., Alayat M.S. Effect of pulsed Nd:yaG laser in the treatment of neuropathic foot ulcers in children with spina bifida: a randomized controlled study. Photomed Laser Surg. 2013;31(12):565-570. doi: 10.1089/pho.2013.3533.
  14. Pandey A., Gupta V., Singh S.P., Kumar V., Verma R. Neuropathic ulcers among children With Neural Tube Defects: aReview of literature. Ostomy Wound Manage. 2015;61(12):32-38.
  15. Freeman G.J., Mackie K.M., Sare J., Walsh A.K., Pherwani A.D. A novel approach to the management of the diabetic foot: metatarsal excision in the treatment of osteomyelitis. Eur J Vasc Endovasc Surg.2007;33(2):217-219. doi: 10.1016/j.ejvs.2006.10.008.
  16. Marais L.C., Ferreira N., Aldous C. The classification of chronic osteomyelitis. SA Orthopc J Autumn. 2014;13(1):22-28. available from: http://saoajournal.ps.studio/index.php/saoj/article/view/181.
  17. Kirshblum S.C., Burns S.P., Biering-Sorensen F., Donovan W., Graves D.E., Jha. A. et al. International standards for neurological classification of spinal cord injury (revised 2011). J Spinal Cord Med. 2011;34(6):535-546. doi: 10.1179/204577211x13207446293695.
  18. Kitaoka H.B., Alexander I.J., Adelaar R.S., Nunley J.A., Myerson M.S., Sanders M. Clinical rating systems for the ankle-hind foot, mid-foot, hallux and lesser toes. Foot Ankle Int. 1994;15:135-149.
  19. Werner S., Grose R. Regulation of Wound Healing by Growth factors and cytokines. Physiol Rev. 2003;83:835-870. DOI: 10,1152/physrev.2003.83.3.835.
  20. Kadam D. Microsurgical Reconstruction of Plantar ulcers of the Insensate foot. J Reconstr Microsurg. 2016;32(5):402-410. doi: 10.1055/s-0036-1579536.
  21. Broughton N.S., Graham G., Menelaus M.B. The high incidence of foot deformity in patients with high-level spina bifida. J Bone Joint Surg Br. 1994;76(4):548-550.
  22. Gunay H., Sozbilen M.C., Gurbuz Y., Altinisik M., Buyukata B. Incidence and type of foot deformities in patients with spina bifida according to level of lesion. Childs Nerv Syst. 2016;32(2):315-319. doi: 10.1007/s00381-015-2944-7.
  23. Calhoun J.H., Manring M.M., Shirtliff M. Osteomyelitis of the long bones. Semin Plast Surg. 2009;23(2):59-72. doi: 10.1055/s-0029-1214158.
  24. Глухов А.А., Алексеева Н.Т., Микулич Е.В. Морфологические изменения в костной ткани при хроническом остеомиелите на фоне применения тромбоцитарного концентрата. Успехи современного естествознания. 2011;12:36-38. Режим доступа: http://www.natural-sciences.ru/ru/article/view?id=28992.
  25. Schmidt H.G., Tiemann A.H., Braunschweig R., Diefenbeck M., Bühler M., Abitzsch D., Haustedt N., Walter G., Schoop R., Heppert V., Hofmann G.O., Glombitza M., Grimme C., Gerlach U.J., Flesch I. Definition of the Diagnosis osteomyelitis-osteomyelitis Diagnosis Score (oDS). Z Orthop Unfall.2011;149(4):449-460. (In German). doi: 10.1055/s-0030-1270970.
  26. Tiemann A., Hofmann G.O., Krukemeyer M.G., Krenn V., Langwald S. Histopathological osteomyelitis evaluation Score (HoeS) — an innovative approach to histopathological diagnostics and scoring of osteomyelitis. Interdiscip Plast Reconstr Surg DGPW. 2014;3:Doc08. doi: 10.3205/iprs000049.
  27. Байрамкулов Э.Д., Воротников А.А., Мозеров С.А., Красовитова О.В. Клинико-морфологическая характеристика остеомиелита при синдроме диабетической стопы. Фундаментальные исследования. 2015;1-1:23-27. Режим доступа: http://www.fundamental-research.ru/ru/article/view?id=36758.

Statistics

Views

Abstract: 322

Dimensions

Article Metrics

Metrics Loading ...

PlumX


Copyright (c)



This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies