Trabecularization of the cortical plate in chronic osteomyelitis

Introduction Literature data and analysis of our own material indicate a change in the density of the long bone cortical plate in patients with chronic osteomyelitis along its extension; however, the nature and degree of structural disorders of the cortical layer beyond the inflammation zone is an unexplored area of radiomorphology. Objective To study the structural features of the cortical plate of the femur and tibia outside the inflammation nidus and the change in its structure in the form of trabecularization. Material and methods The study is retrospective single-center work of level of evidence IV. In 86 patients with chronic osteomyelitis of the long bones of the lower extremities, using polypositional radiography and multislice computed tomography (MSCT), the features of radiological morphology of the femur and tibia were studied in order to identify structural features and quantify the density of the cortical plate and its trabecularization. Results The cause of the inflammatory process in the bone in 83 cases was trauma or surgery, and consequences of hematogenous osteomyelitis in three cases. The most common location of chronic osteomyelitis was the distal femur (24) and tibia (25) bones. Due to long-term disease, nonunion or a bone defect developed in 11 patients. Analysis of MSCT data in 86 patients with chronic osteomyelitis showed that anatomical changes in the femur and tibia and the density characteristics of the cortical plate near the focus of destruction were manifested in 79.5 % of patients with a decrease in the thickness of the cortical plate (up to 2 mm) with complete trabecularization in separate areas with density from 290 to 360HU in 47.7 % of the examined. Conclusion Radiological morphological changes in the cortical plate of the femur and tibia in patients with chronic osteomyelitis near the focus of destruction were characterized by a decrease in the thickness and density of the cortical plate, accompanied by its complete or partial trabecularization with a density not exceeding 315.5 ± 38.6 Hounsfield units (HU) in 41 ( 47.7 %) of 86 patients.