Strategies in Trauma and Limb Reconstruction

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VOLUME 19 , ISSUE 1 ( January-April, 2024 ) > List of Articles


Critical Bone Defect Affecting the Outcome of Management in Anatomical Type IV Chronic Osteomyelitis

Shao-Ting J Tsang, Gadi Z Epstein, Nando Ferreira

Keywords : Cierny and Mader classification, Chronic osteomyelitis, Critical bone defect

Citation Information : Tsang SJ, Epstein GZ, Ferreira N. Critical Bone Defect Affecting the Outcome of Management in Anatomical Type IV Chronic Osteomyelitis. 2024; 19 (1):26-31.

DOI: 10.5005/jp-journals-10080-1610

License: CC BY-NC 4.0

Published Online: 06-05-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Background: The Cierny and Mader classification assists with decision-making by stratifying host status and the pathoanatomy of the disease. However, the anatomical type IV represents a heterogenous group with regard to treatment requirements and outcomes. We propose that modification of the Cierny and Mader anatomical classification with an additional type V classifier (diffuse corticomedullary involvement with an associated critical bone defect) will allow more accurate stratification of patients and tailoring of treatment strategies. Methods: A retrospective review of 83 patients undergoing treatment for Cierny and Mader anatomical type IV osteomyelitis of the appendicular skeleton at a single centre was performed. Results: Risk factors for the presence of a critical bone defect were female patients [OR 3.1 (95% CI, 1.08–8.92)] and requirement for soft tissue reconstruction [OR 3.35 (95% CI, 1.35–8.31)]; osteomyelitis of the femur was negatively associated with the presence of a critical bone defect [OR 0.13 (95% CI, 0.03–0.66)]. There was no statistically significant risk of adverse outcomes (failure to eradicate infection or achieve bone union) associated with the presence of a critical-sized bone defect. The median time to the bone union was ten months (95% CI, 7.9–12.1 months). There was a statistically significant difference in the median time to bone union between cases with a critical bone defect [12.0 months (95% CI, 10.2–13.7 months)] and those without [6.0 months (95% CI, 4.8–7.1 months)]. Conclusion: This study provided evidence to support the introduction of a new subgroup of the Cierny and Mader anatomical classification (Type V). Using a standardised approach to management, comparable early outcomes can be achieved in patients with Cierny and Mader anatomical type V osteomyelitis. However, to achieve a successful outcome, there is a requirement for additional bone and soft tissue reconstruction procedures with an associated increase in treatment time.

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