The Beit CURE Classification of Childhood Chronic Haematogenous Osteomyelitis—a guide to treatment

Abstract

BackgroundThe Beit CURE (BC) classification is a radiographic classification used in childhood chronic haematogenous osteomyelitis. The aim of this study is to assess correlation between this classification and the type and extent of treatment required.MethodsWe present a retrospective series of 145 cases of childhood chronic haematogenous osteomyelitis classified using the BC classification. Variables measured include age, sex, bone involved, number of admissions, length of stay, type/number of operations and microbiology.ResultsThe most commonly affected bone was the tibia (46 %), followed by femur (26 %) and humerus (10 %). Bone defects were most common in the tibia. Staphylococcus aureus was the most commonly isolated organism.Type B, sequestrum type, was the most common (88 %), followed by type C, sclerotic type, (7 %) and type A, Brodie’s abscess (5 %).Types A and B1 had the shortest length of hospitalisation (11 days), type B4 had the longest (87 days). Types A and B1 had the fewest infection control operations. Type B4 had the greatest total number of operations.ConclusionsThis study shows that the BC classification can guide surgical strategy and help predict length of inpatient treatment and number and type of procedures required.

Orthopaedic biofilm infections

“…In a study on 67 patients with posttraumatic and postoperative (exogenous) osteomyelitis, 33% were caused by coagulase-negative staphylococci, 30% Table 1. Different pathogenetic types of chronic osteomyelitis Persistent chronic osteomyelitis after exclusive surgical therapy during the preantibiotic era (9,10) Chronic haematogenous osteomyelitis in children (6,11,12) Progression to chronic osteomyelitis because of insufficient diagnostic work-up in patients treated for deep soft-tissue infection (18,19) Diabetic foot osteomyelitis (14) Osteomyelitis in patients with sacral pressure ulcer (13,15) Sternal wound osteomyelitis after sternotomy (16) Persistent chronic osteomyelitis in patients with insufficiently treated infection associated with an internal fracture fixation device (17) by S. aureus, 21% by Gram-negative bacilli and 19% by Enterococcus spp. In 9% of the cases, no microorganism could be detected (25).…”

“…In addition, an appropriate combined surgical and antibiotic management of implant-associated infection ameliorated during the last decades (7,8). The most frequent types of chronic osteomyelitis are summarized in Table 1 (6,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). There are several publications, reporting late recurrence of chronic osteomyelitis in patients who suffered from acute osteomyelitis in the preantibiotic era or in their childhood.…”

Predictors of musculoskeletal manifestations in paediatric patients presenting with sickle cell disease at a tertiary teaching hospital in Lusaka, Zambia

“…We ensured that the patients remained comfortable during the procedures and that minimal pain was caused by the needle during blood collection. Staging the severity of chronic osteomyelitis was done using the Beit Cure classification 14 (Table I). The Ficats classification was used in the staging of AVN of the femoral head.…”

Osteomyelitis

“…Bone defects are present in 20 % of cases of COM [ 18 ] and can range from a pathological fracture to large segmental defects. The management of these is diffi cult.…”