The Osteomyelitis Staging System of Cierny and Mader

Description

The staging system of Cierny and Mader for osteomyelitis uses both the anatomy of the bone infection and the physiologic status of the host. This allows development of precise treatment guidelines to match the conditions of the infection. This system does not designate acute versus chronic infection, since large areas of necrotic tissue need to be removed regardless of duration of the infection.

Anatomic Type	Description
Stage 1	medullary osteomyelitis
Stage 2	superficial osteomyelitis
Stage 3	localized osteomyelitis
Stage 4	diffuse osteomyelitis

Medullary osteomyelitis (Stage 1):

(1) infection confined to the intramedullary space

(2) examples: hematogenous osteomyelitis, infected intramedullary rod

Superficial osteomyelitis (Stage 2):

(1) focus of osteomyelitis in bone contiguous to a focus of soft tissue infection or ulceration

Localized osteomyelitis (Stage 3):

(1) full-thickness cortical sequestration that can be removed surgically without compromise of bony stability

Diffuse osteomyelitis (Stage 4):

(1) through-and-through process requiring an intercallary resection of bone to arrest the disease process

(2) includes infections with loss of bony stability before or after surgical debridement

Physiologic Class	Subtype	Description
A host		normal host
B host	Bs	systemic compromise
	Bl	localized compromise
	Bls	systemic and local compromise
C host		treatment worse than the disease

Type of Compromise	Subtype	Factors
systemic	Bs	malnutrition
		renal failure
		hepatic failure
		diabetes mellitus
		chronic hypoxia, including hemoglobinopathy
		immune disease
		malignancy
		extremes of age
		immunosuppression or immune deficiency
local	Bl	chronic lymphedema
		venous stasis
		major vessel compromise
		arteritis
		extensive scarring
		radiation fibrosis
		small vessel disease
		neuropathy
		heavy tobacco use (>= 2 packs of cigarettes per day)

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The Osteomyelitis Staging System of Cierny and Mader

Description

Specialty