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Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2018)

23.10. - 26.10.2018, Berlin

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The value of quantitative histology in the diagnosis of fracture – related infection

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  • presenting/speaker Mario Morgenstern - Universitätsspital Basel, Basel, Switzerland
  • Nick Athanasou - Department of Pathology, Rheumatology and Musculoskeletal Science, Oxford, United Kingdom
  • Jamie Ferguson - Bone Infection Unit, Oxford, United Kingdom
  • Willem-Jan Metsemakers - Department of Trauma Surgery, Leuven, Belgium
  • Bridget Atkins - Bone Infection Unit, Oxford, United Kingdom
  • Martin McNally - Bone Infection Unit, Oxford, United Kingdom

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2018). Berlin, 23.-26.10.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. DocPT13-733

doi: 10.3205/18dkou607, urn:nbn:de:0183-18dkou6075

Veröffentlicht: 6. November 2018

© 2018 Morgenstern et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.

Gliederung

Text

Objectives: The aim was to investigate the value of quantitative histological analysis in the diagnosis of fracture-related infection (FRI).

Methods: The clinical features, microbiology culture results and histological analysis in 156 surgically treated non-unions were used to stratify the likelihood of associated infection. There were 64 confirmed infected non-unions (at least 1 confirmatory criteria; pus, sinus and bacterial growth in at least 2 samples), 66 aseptic non-unions (no confirmatory criteria) and 26 possibly infected (pathogen identified from a single specimen and no confirmatory criteria). The histological inflammatory response was assessed by average neutrophil polymorphs (NPs) counts per high power field (HPF) and compared to the established diagnosis.

Results and conclusion: Assuming a cut-off of >5NPs/HPF for positive histological diagnosis, there was 80% sensitivity and 100% specificity (accuracy 90%). Using a cut-off of any NPs/HPF (>0) for negative histological diagnosis there was a sensitivity of 98% and a specificity of 85% (accuracy 92%).

In conclusion, histology can be used in a bimodal fashion as a diagnostic test for FRI. The presence of >5 NPs/HPF has a positive predictive value of 100%, while the complete absence of any NPs is almost always indicative of an aseptic non-union (negative predictive value: 98%).