Cierny-Mader staging system for long bone osteomyelitis
Cierny and Mader classified osteomyelitis based on the affected portion of the bone, the physiologic status of the host and the local environment. This classification lends itself to the treatment and prognosis of osteomyelitis; stage 1 (medullary osteomyelitis) can usually be treated with antibiotics alone, while stages 2, 3 and 4 (superficial, localized and diffuse osteomyelitis) usually require aggressive debridement, antimicrobial therapy and subsequent orthopedic reconstruction.
Cierny-Mader staging system for long bone osteomyelitis
Anatomic type
Stage 1: Medullary osteomyelitis
Medullary osteomyelitis denotes infection confined to the intramedullary surfaces of the bone. Hematogenous osteomyelitis and infected intramedullary rods are examples of this anatomic type.
Stage 2: Superficial osteomyelitis
Superficial osteomyelitis is a true contiguous focus infection of bone; it occurs when an exposed infected necrotic surface of bone lies at the base of a soft-tissue wound.
Stage 3: Localized osteomyelitis
Localized osteomyelitis is usually characterized by a full thickness, cortical sequestration which can be removed surgically without compromising bony stability.
Stage 4: Diffuse osteomyelitis
Diffuse osteomyelitis is a through-and-through process that usually requires an intercalary resection of the bone to arrest the disease process. Diffuse osteomyelitis includes those infections with a loss of bony stability either before or after debridement surgery.
Physiologic class of host
Class A denotes a normal host
Class B denotes a host with systemic compromise, local compromise, or both
Class C denotes a host for whom the morbidity of treatment is worse than that imposed by the disease itself
Cierny-Mader staging system for long bone osteomyelitis
Anatomic type
Stage 1: Medullary osteomyelitis
Medullary osteomyelitis denotes infection confined to the intramedullary surfaces of the bone. Hematogenous osteomyelitis and infected intramedullary rods are examples of this anatomic type.
Stage 2: Superficial osteomyelitis
Superficial osteomyelitis is a true contiguous focus infection of bone; it occurs when an exposed infected necrotic surface of bone lies at the base of a soft-tissue wound.
Stage 3: Localized osteomyelitis
Localized osteomyelitis is usually characterized by a full thickness, cortical sequestration which can be removed surgically without compromising bony stability.
Stage 4: Diffuse osteomyelitis
Diffuse osteomyelitis is a through-and-through process that usually requires an intercalary resection of the bone to arrest the disease process. Diffuse osteomyelitis includes those infections with a loss of bony stability either before or after debridement surgery.
Physiologic class of host
Class A denotes a normal host
Class B denotes a host with systemic compromise, local compromise, or both
Class C denotes a host for whom the morbidity of treatment is worse than that imposed by the disease itself