- 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.
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