Osteomyelitis classification: Difference between revisions
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*'''Acute''': Acute osteomyelitis typically presents with gradual onset of symptoms over several days and less than 2 weeks. | |||
*'''Sub-acute''': Subacute hematogenous osteomyelitis has a more insidious onset and lacks the severity of symptoms, which makes the diagnosis of this disorder difficult. Typically, diagnosis is delayed for more than 2 weeks. | |||
Revision as of 16:31, 23 December 2016
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Nate Michalak, B.A.
Overview
Two classification schemes are currently used. Lew and Waldvogel classify osteomyelitis according to duration and mechanism of infection: hematogenouos osteomyelitis, contiguous-focus osteomyelitis, and osteomyeltis secondary to vascular insufficiency. Cierny and Mader classify osteomyelitis according to anatomy of bone infection and host physiology. This systems classifies the location of infection into 4 stages and the host's physiology into 3 levels of compromise.
Classification
There are many types of classification schemes exist for osteomyelitis:
- Lew and Waldvogel classify osteomyelitis according to duration and mechanism of infection (traditional classification)[1]
- Cierny and Mader classify osteomyelitis according to anatomy of bone infection and host physiology[2]
- The Cierny and Mader system offers a guide to treatment
Classification based on symptom chronology
- Acute: Acute osteomyelitis typically presents with gradual onset of symptoms over several days and less than 2 weeks.
- Sub-acute: Subacute hematogenous osteomyelitis has a more insidious onset and lacks the severity of symptoms, which makes the diagnosis of this disorder difficult. Typically, diagnosis is delayed for more than 2 weeks.
Lew and Waldvogel Etiologic System
| Mechanism of Infection | Description |
|---|---|
| Hematogenous Osteomyelitis | Osteomyelitis develops after bacteremia |
| Contiguous-focus Osteomyelitis | Direct inoculation of bone via trauma/fracture, surgery, prosthetic devices, or spread from soft tissue |
| Osteomyelitis Secondary to Vascular Insufficiency | Reduced blood supply, usually in diabetic patients |
Cierny and Mader Staging System
| Classification | Description | |
|---|---|---|
| Anotomic Type | Stage 1 | Medullary osteomyeltitis: infection confined to the intramedullary bone surfaces |
| Stage 2 | Superficial osteomyelitis: true contiguous infection (bone surface undergoes necrosis at the base of a soft tissue wound) | |
| Stage 3 | Localized osteomyelitis: full-thickness, cortical sequestration | |
| Stage 4 | Diffuse osteomyelitis: through-and-through process requiring intercalary reconstruction of bone | |
| Physiological Class | A Host | Normal physiological, metabolic, and immunologic states |
| B Host | Local compromise, systemic compromise, or both | |
| C Host | Morbidity of treatment is worse than disease |
References
- ↑ Lew, Daniel P.; Waldvogel, Francis A. (1997). "Osteomyelitis". New England Journal of Medicine. 336 (14): 999–1007. doi:10.1056/NEJM199704033361406. ISSN 0028-4793.
- ↑ Mader, Jon T.; Shirtliff, Mark; Calhoun, Jason H. (1997). "Staging and Staging Application in Osteomyelitis". Clinical Infectious Diseases. 25 (6): 1303–1309. doi:10.1086/516149. ISSN 1058-4838.