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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.