In Cierny-Mader classification of adult osteomyelitis, a Stage III lesion is characterised by which anatomical distribution and host status, and what surgical implication does it carry?

• A Stage III — medullary osteomyelitis involving only the endosteum; managed by medullary reaming alone
• B Stage III — diffuse osteomyelitis involving the entire bone circumference; requires segmental resection destabilising the bone
• C Stage III — localised osteomyelitis with full-thickness cortical sequestrum but intact skeletal stability; allows surgical debridement without destabilising the bone ✓
• D Stage III — superficial osteomyelitis involving only the outer cortex; managed with local debridement and wound care

Explanation

The Cierny-Mader classification has four anatomical types: Type I (medullary), Type II (superficial), Type III (localised), and Type IV (diffuse). Type III (localised) is defined as full-thickness cortical involvement with a well-marginated sequestrum, but the segment retains skeletal stability before and after debridement — a key distinction from Type IV (diffuse), where circumferential cortical destruction causes instability after debridement. This allows aggressive surgical debridement of Type III without requiring simultaneous stabilisation, unlike Type IV which may need external fixation or bone transport.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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