TY - JOUR

T1 - Intraoperative tissue sampling for histology in chronic osteomyelitis shows high neutrophil infiltration centrally and low remains in debrided presumed infection-free regions

AU - Jensen, Louise Kruse

AU - Jensen, Henrik Elvang

AU - Gottlieb, Hans

PY - 2024

Y1 - 2024

N2 - Introduction: Histology of debrided bone tissue is a confirmatory diagnostic criterion for fracture related infection(FRI) and prosthetic joint infection (PJI). The aim of the present study was to describe the histopathology of thefirst and last debrided bone tissue in chronic osteomyelitis (CO) according to the international diagnosticguidelines for FRI and PJI.Methods: 15 patients with CO were allocated to surgical treatment using a one-stage protocol including extensivedebridement. Suspected infected bone tissue eradicated early in the debridement procedure was collected as aclearly infected sample (S1). Likewise, the last eradicated bone tissue was collected as a suspected non-infectedsample (S2). The samples were processed for histology. HE-stained sections were patho-morphologicallyexaminated. Immunohistochemistry with MAC-387 antibodies towards calprotectin was used for estimation ofneutrophil granulocyte (NP) score (0, 1, 2 or 3).Results: S1 samples showed a mean NP score of 2.6 (3 is confirmatory for infection). Following debridement, theNP score was significantly (p = 0.005) reduced to a mean NP score of 1.6. The S1 samples showed a mix offibrovascular tissue, dense fibrosis, viable bone, bone necrosis and bone debris. S2 samples contained mostlyviable bone tissue, however, often small fragments of necrotic bone or bone debris were present.Conclusion: The inflammatory response of CO still exists after debridement, although the response fades from thecenter. Therefore, sampling of debrided bone tissue for histology must be performed initially during surgery,otherwise there is a risk for underestimation of NP infiltration. The present results might also be highly relevantfor FRI and PJI.

AB - Introduction: Histology of debrided bone tissue is a confirmatory diagnostic criterion for fracture related infection(FRI) and prosthetic joint infection (PJI). The aim of the present study was to describe the histopathology of thefirst and last debrided bone tissue in chronic osteomyelitis (CO) according to the international diagnosticguidelines for FRI and PJI.Methods: 15 patients with CO were allocated to surgical treatment using a one-stage protocol including extensivedebridement. Suspected infected bone tissue eradicated early in the debridement procedure was collected as aclearly infected sample (S1). Likewise, the last eradicated bone tissue was collected as a suspected non-infectedsample (S2). The samples were processed for histology. HE-stained sections were patho-morphologicallyexaminated. Immunohistochemistry with MAC-387 antibodies towards calprotectin was used for estimation ofneutrophil granulocyte (NP) score (0, 1, 2 or 3).Results: S1 samples showed a mean NP score of 2.6 (3 is confirmatory for infection). Following debridement, theNP score was significantly (p = 0.005) reduced to a mean NP score of 1.6. The S1 samples showed a mix offibrovascular tissue, dense fibrosis, viable bone, bone necrosis and bone debris. S2 samples contained mostlyviable bone tissue, however, often small fragments of necrotic bone or bone debris were present.Conclusion: The inflammatory response of CO still exists after debridement, although the response fades from thecenter. Therefore, sampling of debrided bone tissue for histology must be performed initially during surgery,otherwise there is a risk for underestimation of NP infiltration. The present results might also be highly relevantfor FRI and PJI.

U2 - 10.1016/j.injury.2023.111178

DO - 10.1016/j.injury.2023.111178

M3 - Journal article

C2 - 37952476

VL - 55

JO - Injury

JF - Injury

SN - 0020-1383

IS - 2

M1 - 111178

ER -