A diabetic 65-year-old man has a chronic infected non-healing wound over the first metatarsal head for 3 months. MRI shows bone marrow oedema and cortical erosion of the first metatarsal head consistent with chronic osteomyelitis. The Cierny-Mader classification for this lesion would be:

• A Type III (localised) with Type B host ✓
• B Type I (medullary) with Type B (systemic compromise) host
• C Type IV (diffuse) with Type C host
• D Type II (superficial) with Type A host

Explanation

The Cierny-Mader classification describes anatomical type and physiological host class. Type III (localised) osteomyelitis involves a full-thickness cortical sequestrum that is stable without surgical intervention but requires debridement; it does not involve the full medullary canal (Type I) nor does it extend through the entire bone segment (Type IV). Diabetes mellitus makes this patient a Type B host (systemic compromise). A Type A host is healthy; Type C means the cure risk exceeds the disease risk and surgery is contraindicated. Type II (superficial) is confined to the surface without medullary involvement.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.