From the Research
Chronic osteomyelitis and avascular bone can be differentiated based on their distinct histologic features, with chronic osteomyelitis showing inflammatory cell infiltration and avascular bone exhibiting empty lacunae and a lack of viable cells. The histologic features of chronic osteomyelitis include:
- Inflammatory cell infiltration, predominantly neutrophils, lymphocytes, and plasma cells
- Areas of bone destruction and reactive new bone formation
- Fibrosis and granulation tissue, with microabscesses and sequestra (dead bone fragments) surrounded by inflammatory cells
- Bacterial colonies may be visible with special stains In contrast, avascular bone (osteonecrosis) exhibits:
- Empty lacunae where osteocytes have died, with no viable cells in the affected bone
- The bone architecture remains intact initially but appears pale and eosinophilic
- A clear demarcation between dead and viable bone, with a reparative zone containing fibrovascular tissue and osteoclasts at this junction
- Bone marrow in avascular areas shows fat necrosis with foamy macrophages, as noted in studies such as 1 and 2. These histologic differences reflect their distinct pathophysiology, with chronic osteomyelitis resulting from persistent infection and avascular bone resulting from interrupted blood supply leading to tissue death without primary infection, as discussed in 3 and 4. Key differences between the two conditions include the presence of inflammatory cells in chronic osteomyelitis and the lack of viable cells in avascular bone, as well as the presence of bacterial colonies in chronic osteomyelitis, as mentioned in 5. Overall, the histologic features of chronic osteomyelitis and avascular bone are distinct and can be used to differentiate between these two conditions, as supported by the evidence from 3, 5, 1, 4, and 2.