Cierny Classification of Osteomyelitis



- Discussion:
    - there are four main considerations in classifying osteomyelitis;
            - condition of the host
            - functional impairment caused by the disease
            - site of involvement
            - extent of bony necrosis

- Classification:
    - host immune status:
            - type A: normal immune status;
            - type B: some degree of immunocomprimised status; (pts may be at risk for graft resorbtion w/ primary grafting);
            - type C: significant immunocomprimised status;
    - type I:
            - medullary osteomyelitis w/ endosteal nidus;
            - does not necessarily require bone grafting;
    - type II:
            - superficial osteomyelitis, affecting outer surface of bone;
            - examples include an infected plate in a healed frx, bone exposure 2nd to soft-tissue loss, or an adjacent soft-tissue abscess abutting cortex;
            - usually soft tissue comprimise is common;
            - treatment involves:
                    - stabilization by definition is not required (otherwise this is classified as type III or IV):
                    - hardware removal and debridement of avascular outer cortex (down to bleeding bone - "paprika sign");
                    - antibiotic beads;
                    - coverage;
                    - bone grafting;
    - type III:
            - well marginated sequestration of cortical bone;
            - can be excised w/ creating instability;
            - treatment involves:
                    - stabilization;
                    - debridement;
                    - antibiotic beads;
                    - coverage;
                    - bone grafting;
    - type IV:
            - permeative destructive lesion causing instability (infected tibial non union)



A clinical staging system for adult osteomyelitis.

Limb salvage for chronic tibial osteomyelitis: an outcomes study.

The treatment of chronic open osteomyelitis of the tibia in adults.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Friday, November 30, 2012 3:12 pm