The Classification of Long Bone Osteomyelitis: A Systemic Review of the Literature

Abstract

Background: Osteomyelitis is a complex disease. Treatment involves a combination of bone resection, antimicrobials and soft-tissue coverage. There is a difficulty in unifying a classification system for long bone osteomyelitis that is generally accepted.Objectives: In this systematic review, we aim to investigate the classification systems for long bone osteomyelitis that have been presented within the literature. By doing this, we hope to elucidate the important variables that are required when classifying osteomyelitis.Methods: A complete search of the Medline, EMBASE, Cochrane and Ovid databases was undertaken. Following exclusion criteria, 13 classification systems for long-bone osteomyelitis were included for review.Results: The 13 classification systems that were included for review presented seven different variables that were used for classification. Ten of them used only one main variable, two used two variables and one used seven variables. The variables included bone involvement (used in 7 classification systems), acute versus chronic infection (used in 6), aetiopathogenesis (used in 3), host status (used in 3), soft tissue (used in 2), microbiology (used in 1) and location of infected bone (used in 1). The purpose of each classification system could be grouped as either descriptive (3 classification systems), prognostic (4) or for management (4). Two of the 13 classification systems were for both prognostic and management purposes.Conclusions: This systematic review has demonstrated a variety of variables used for classification of long bone osteomyelitis. While some variables are used to guide management and rehabilitation after surgery (e.g., bone defect, soft tissue coverage), others were postulated to provide prognostic information (e.g., host status). Finally, some variables were used for descriptive purposes only (aetiopathogenesis). In our view and from today's perspective, bone involvement, antimicrobial resistance patterns of causative micro-organisms, the need for soft-tissue coverage and host status are important variables to include in a classification system.

General treatment principles for fracture-related infection: recommendations from an international expert group

“…Several important factors, other than time after fracture fixation, influence the decision-making process with respect to the main surgical concepts of FRI treatment: debridement and retention versus debridement and removal or exchange. Recent publications have presented more elaborate classifications like the "Seven-Item Comprehensive Classification System" [12] and the BACH [13] classification system. However, currently no classification is available that is tailored specifically to the FRI patient, is easy to use in daily practice and considers essential factors to guide treatment.…”

“…The main purpose of such a classification should be to guide antimicrobial and surgical treatment decisions. It would also aid the identification of complex cases, where a multidisciplinary approach in a specialized center should be strongly considered [13].…”

The Value of Ortho-ID Teams in Treating Bone and Joint Infections

“…The heterogeneity of cases and definitions in clinical practice and attendant clinical data caused a burden for useful conclusions. The collaborations of orthopaedic and trauma surgeons and ID physicians have led to a continuously evolving and improved structure in defining and understanding osteomyelitis of long bones [24,25], fracture related infections [26] and prosthetic joint infections [22] .…”

Should We Think More About Chronic Osteomyelitis After Trauma? A Case Report of Osteomyelitis of the Cuboid Bone

“…Osteomyelitis is a common clinical infectious disease that is frequently encountered by orthopedic surgeons. Chronic osteomyelitis describes infection and in ammation of bone accompanied by skin ulceration and pus out ow, and the sinus remains open for a long time without healing [1]. If it remains untreated, osteomyelitis can lead to tissue destruction and loss of function or even permanent disability [2,3].…”