Histologic Features of Necrotic Bone

 

Parameters:

(1) cells in the lacunae

(2) staining quality of the osteoid

(3) edge of the osteoid

(4) osteoclasts (multi-nucleated cells at the osteoid edge or in Howship's lacunae)

Parameter	Viable Bone	Dead Bone
cells in lacunae	present	absent ("empty")
staining quality	normal (eosinophilic)	basophilic
osteoid edge	even	ragged and uneven
osteoclasts	not increased	increased and active

 

where:

• Loss of cells in the lacunae is an early finding.

• Proliferation of osteoclasts is a late response.

 

Later events:

(1) fibrosis in the medullary spaces (which must be distinguished from pre-existing fibrosis)

(2) proliferation of osteoblasts with bone replacement (which must be distinguished from previous osteoblastic activity).

 

Limitation:

• Overdecalcification can cause artifacts that may mimic bone necrosis. This may occur if too strong an acid was used and/or the bone was left too long in the solution.

• Pre-existing bone disease will modify the response.