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Journal of Bone and Joint Infection An open-access journal of the European Bone and Joint Infection Society and the MusculoSkeletal Infection Society
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Volume 2, issue 4
J. Bone Joint Infect., 2, 167–174, 2017
© Author(s) 2017. This work is distributed under
the Creative Commons Attribution 4.0 License.
J. Bone Joint Infect., 2, 167–174, 2017
© Author(s) 2017. This work is distributed under
the Creative Commons Attribution 4.0 License.

Review 12 Sep 2017

Review | 12 Sep 2017

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

Andrew J. Hotchen1,2, Martin A. McNally1, and Parham Sendi1,3,4,5 Andrew J. Hotchen et al.
  • 1Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK;
  • 2Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK;
  • 3Institute for Infectious Diseases, University of Bern, Bern, Switzerland;
  • 4Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland;
  • 5Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University Basel, Basel, Switzerland.

Keywords: Long-bone osteomyelitis, Classification, Bone and Joint Infection.

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.

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