Morphometric Parameters of Lower Leg Tissues and Their Correlation with Laboratory Data in Patients with Post-Traumatic Osteomyelitis

Background. Knowledge  about  the  pathological  processes  in  the  tissues  of  the  limb  is  necessary  for  the  targeted optimization of their course, the expectation of certain treatment results. The aim of the study was to determine the ratio of different severity cases and the correlation between individual clinical, laboratory and morphometric indicators of the tissues state in patients with trophic disorders in the extremity.

Materials and Methods.The material was fragments of the lower leg tissues (bones, soft tissues, skin) of 38 patients with chronic post-traumatic osteomyelitis. Gradation morphometric  indicators  reflecting  the  tissues  state  in  the  lesion  focuses  were  used.  Frequency  analysis  of  semiquantitative indicators and correlation analysis of the relationships between clinical, laboratory and morphometric indicators with the evaluation of the association coefficient were carried out.

 Results.Trophic disorders in the limb tissues (bones, soft tissues, muscles, skin), observed in patients with lower leg bones post-traumatic osteomyelitis, do  not  represent  a  group  of  well-defined  pathological  processes.  They  form  a  complex  of  dyscirculatory,  ischemic, necrotic, dystrophic, atrophic, inflammatory, reparative and regenerative changes, which are combined in tissues in different proportions. This involves the use of a number of quantitative and semi-quantitative, gradation indicators: clinical, laboratory, and pathomorphological. Pathomorphological changes in the lesions in patients with chronic posttraumatic osteomyelitis of the lower leg bones with clinical signs of trophic disorders do not differ qualitatively from the changes usually detected in chronic post-traumatic osteomyelitis. In the bones, the most frequent are destructive focuses with a predominance of exudative and productive inflammation of high activity, sequestration and osteonecrosis. In paraossal soft tissues, more common are focuses, in which mature fibrous tissue and productive inflammation of low activity predominate. In the skin near the chronic post-traumatic osteomyelitis focuses, there is dermis fibrosis and productive inflammation of low activity.

Conclusion. A number of correlations between clinical and laboratory parameters, on the one hand, and morphological parameters, on the other, have been established. The closest and most stable connections for different sites are the following indicators: blood leukocytes (negative dependence for affected bone, soft tissue and skin tissues), ESR (positive dependence for soft tissues), C-reactive protein (positive dependence for soft tissues and skin), agglutination with a polyvalent strain of Staphylococcus aureus (negative dependence for affected bones and skin).