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. | *'''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. | *'''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. | ||
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! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=3 | {{fontcolor|#FFFFFF|Sub-acute osteomyelitis}} | |||
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! rowspan="1" colspan="1" |TYPE | |||
! rowspan="1" colspan="1" |GLEDHILL CLASSIFICATION | |||
! rowspan="1" colspan="1" |ROBERT ET AL. CLASSIFICATION | |||
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| style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1 |{{fontcolor|#FFFFFF|I}} | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Solitary localized zone of radiolucency surrounded<BR> by reactive new bone formation | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Ia—Punched-out radiolucency<BR>Ib—Punched-out radiolucent lesion with sclerotic margin | |||
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| style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1 |{{fontcolor|#FFFFFF|II}} | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Metaphyseal radiolucencies with cortical erosion | |||
| style="padding: 5px 5px; background: #F5F5F5;" | -- | |||
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| style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1 |{{fontcolor|#FFFFFF|III}} | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Cortical hyperostosis in diaphysis; no onion skin reaction | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Localized cortical periosteal reaction | |||
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| style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1 |{{fontcolor|#FFFFFF|IV}} | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Subperiosteal new bone and onion skin layering | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Onion skin periosteal reaction | |||
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| style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1 |{{fontcolor|#FFFFFF|V}} | |||
| style="padding: 5px 5px; background: #F5F5F5;" | -- | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Central radiolucency in epiphysis | |||
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| style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1 |{{fontcolor|#FFFFFF|VI}} | |||
| style="padding: 5px 5px; background: #F5F5F5;" | -- | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Destructive process involving vertebral body | |||
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Revision as of 18:13, 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.
| Sub-acute osteomyelitis | ||||
|---|---|---|---|---|
| TYPE | GLEDHILL CLASSIFICATION | ROBERT ET AL. CLASSIFICATION | ||
| I | Solitary localized zone of radiolucency surrounded by reactive new bone formation |
Ia—Punched-out radiolucency Ib—Punched-out radiolucent lesion with sclerotic margin | ||
| II | Metaphyseal radiolucencies with cortical erosion | -- | ||
| III | Cortical hyperostosis in diaphysis; no onion skin reaction | Localized cortical periosteal reaction | ||
| IV | Subperiosteal new bone and onion skin layering | Onion skin periosteal reaction | ||
| V | -- | Central radiolucency in epiphysis | ||
| VI | -- | Destructive process involving vertebral body | ||
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.