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A NEW CLASSIFICATION OF OSTEOMYELITIS FOR DEVELOPING COUNTRIES
Abstract
ABSTRACT
Background : The term osteomyelitis (OSM) was first coined by Nelaton in 1844. Waldvogel
et al, Cierny-Mader, May et al classifications of OSM from developed countries and Meier
et al’s from Nigeria have been described.
Objective:This new classification was developed to highlight significant pathology seen in
developing countries not covered by existing classifications.
Design: A prospective study.
Setting: University of Ilorin Teaching Hospital, Ilorin, Nigeria.
Subjects: All OSM patients treated from January 1998 to June 2000.
Main outcome measures: Age, sex, clinical features, radiographs and treatment offered were
analysed. Five stages were recognised: stage 0 (potential OSM with bone contamination),
stage I (early or acute OSM), stage II (intermediate OSM with subperiosteal abscess), stage
III (late or chronic OSM with sequestrum and subdivided into IIIa ‘curable’, IIIb ‘controllable’,
IIIc ‘complicated’). Stage IV (compound OSM) with joint involvement: IVa, if anatomical
and IVb if physiological. Patients’ haemoglobin (Hb) status is added to the staging, for
example stage II (Hb SS).
Results: All 271 patients comprising 198 males and 73 females (M: F= 2.7: 1) with age range
2-48 years (mean 29.4 ± 12.2) were studied. Only 93 patients had Hb genotype done; only 42
had Hb S. The stage O had 184 patients (120 open fractures and 64 bone operations). Stage
I had nine patients, stage II 19 patients, stage III 51 patients and stage IV eight.
Conclusions: This new staging incorporates pre-emptive OSM seen in developing countries
where certain practices, if unchecked lead to OSM. The severity of OSM featuring florid
disease not common in the developed world, and for which existing classifications did not
accommodate, is included.
Background : The term osteomyelitis (OSM) was first coined by Nelaton in 1844. Waldvogel
et al, Cierny-Mader, May et al classifications of OSM from developed countries and Meier
et al’s from Nigeria have been described.
Objective:This new classification was developed to highlight significant pathology seen in
developing countries not covered by existing classifications.
Design: A prospective study.
Setting: University of Ilorin Teaching Hospital, Ilorin, Nigeria.
Subjects: All OSM patients treated from January 1998 to June 2000.
Main outcome measures: Age, sex, clinical features, radiographs and treatment offered were
analysed. Five stages were recognised: stage 0 (potential OSM with bone contamination),
stage I (early or acute OSM), stage II (intermediate OSM with subperiosteal abscess), stage
III (late or chronic OSM with sequestrum and subdivided into IIIa ‘curable’, IIIb ‘controllable’,
IIIc ‘complicated’). Stage IV (compound OSM) with joint involvement: IVa, if anatomical
and IVb if physiological. Patients’ haemoglobin (Hb) status is added to the staging, for
example stage II (Hb SS).
Results: All 271 patients comprising 198 males and 73 females (M: F= 2.7: 1) with age range
2-48 years (mean 29.4 ± 12.2) were studied. Only 93 patients had Hb genotype done; only 42
had Hb S. The stage O had 184 patients (120 open fractures and 64 bone operations). Stage
I had nine patients, stage II 19 patients, stage III 51 patients and stage IV eight.
Conclusions: This new staging incorporates pre-emptive OSM seen in developing countries
where certain practices, if unchecked lead to OSM. The severity of OSM featuring florid
disease not common in the developed world, and for which existing classifications did not
accommodate, is included.
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