Critical Bone Defect Affecting the Outcome of Management in Anatomical Type IV Chronic Osteomyelitis.

IF 1 Q3 ORTHOPEDICS

Strategies in Trauma and Limb Reconstruction Pub Date : 2024-01-01 DOI:10.5005/jp-journals-10080-1610

Shao-Ting J Tsang, Gadi Z Epstein, Nando Ferreira

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引用次数: 0

Abstract

Background: The Cierny and Mader classification assists with decision-making by stratifying host status and the pathoanatomy of the disease. However, the anatomical type IV represents a heterogenous group with regard to treatment requirements and outcomes. We propose that modification of the Cierny and Mader anatomical classification with an additional type V classifier (diffuse corticomedullary involvement with an associated critical bone defect) will allow more accurate stratification of patients and tailoring of treatment strategies.

Methods: A retrospective review of 83 patients undergoing treatment for Cierny and Mader anatomical type IV osteomyelitis of the appendicular skeleton at a single centre was performed.

Results: Risk factors for the presence of a critical bone defect were female patients [OR 3.1 (95% CI, 1.08-8.92)] and requirement for soft tissue reconstruction [OR 3.35 (95% CI, 1.35-8.31)]; osteomyelitis of the femur was negatively associated with the presence of a critical bone defect [OR 0.13 (95% CI, 0.03-0.66)]. There was no statistically significant risk of adverse outcomes (failure to eradicate infection or achieve bone union) associated with the presence of a critical-sized bone defect. The median time to the bone union was ten months (95% CI, 7.9-12.1 months). There was a statistically significant difference in the median time to bone union between cases with a critical bone defect [12.0 months (95% CI, 10.2-13.7 months)] and those without [6.0 months (95% CI, 4.8-7.1 months)].

Conclusion: This study provided evidence to support the introduction of a new subgroup of the Cierny and Mader anatomical classification (Type V). Using a standardised approach to management, comparable early outcomes can be achieved in patients with Cierny and Mader anatomical type V osteomyelitis. However, to achieve a successful outcome, there is a requirement for additional bone and soft tissue reconstruction procedures with an associated increase in treatment time.

How to cite this article: Tsang STJ, Epstein GZ, Ferreira N. Critical Bone Defect Affecting the Outcome of Management in Anatomical Type IV Chronic Osteomyelitis. Strategies Trauma Limb Reconstr 2024;19(1):26-31.

查看原文本刊更多论文

影响解剖学 IV 型慢性骨髓炎治疗效果的关键骨缺损。

背景：Cierny 和 Mader 分类法通过对宿主状态和疾病的病理解剖进行分层，有助于做出决策。然而，在治疗要求和结果方面，解剖类型 IV 代表了一个不同的群体。我们建议修改 Cierny 和 Mader 解剖学分类法，增加 V 型分类法（弥漫性皮质髓质受累并伴有临界骨缺损），以便更准确地对患者进行分层并制定治疗策略：方法：对在一个中心接受治疗的83例Cierny和Mader解剖学IV型阑尾骨骨髓炎患者进行回顾性研究：出现临界骨缺损的风险因素是女性患者[OR 3.1 (95% CI, 1.08-8.92)]和需要软组织重建[OR 3.35 (95% CI, 1.35-8.31)]；股骨髓炎与出现临界骨缺损呈负相关[OR 0.13 (95% CI, 0.03-0.66)]。从统计学角度看，出现临界骨缺损与不良后果（未能根除感染或实现骨结合）的风险无明显关联。骨结合的中位时间为 10 个月（95% CI，7.9-12.1 个月）。有临界骨缺损的病例[12.0个月 (95% CI, 10.2-13.7个月)]和没有临界骨缺损的病例[6.0个月 (95% CI, 4.8-7.1个月)]的骨结合中位时间有明显的统计学差异：这项研究为引入 Cierny 和 Mader 解剖学分类的新亚组（V 型）提供了证据支持。通过标准化的治疗方法，Cierny 和 Mader 解剖学 V 型骨髓炎患者可获得相似的早期疗效。然而，要获得成功的疗效，还需要进行额外的骨和软组织重建手术，治疗时间也会随之增加：Tsang STJ, Epstein GZ, Ferreira N. Critical Bone Defect Affecting the Outcome of Management in Anatomical Type IV Chronic Osteomyelitis.Strategies Trauma Limb Reconstr 2024;19(1):26-31.

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来源期刊

Strategies in Trauma and Limb Reconstruction Medicine-Orthopedics and Sports Medicine

CiteScore

1.50

自引率

0.00%

发文量

期刊介绍： Strategies in Trauma and Limb Reconstruction is dedicated to surgeons, allied medical professionals and researchers in the field of orthopaedics and trauma. The scope of the journal is to discuss the fields of skeletal injury, and the complications thereof, congenital and acquired limb deformities and deficiencies, and orthopaedic-related infection, together with their surgical and non-surgical treatments. The journal publishes original articles, reviews, case reports, descriptions of new or recognised treatment techniques, forum discussions of clinical scenarios and relevant correspondence. It aims to provide a widely accessible source of useful information to practitioners in the field through the problem- or technique-based approach of published articles.