Cierny-Mader classification of osteomyelitis is based on anatomic type and physiological host class. A 45-year-old diabetic (uncontrolled, HbA1c 11%), smoker with peripheral neuropathy presents with chronic tibial osteomyelitis involving only the superficial cortex (medullary cavity intact). What is his Cierny-Mader stage and host class?
- A Stage I (Medullary), Host Class A
- B Stage II (Superficial), Host Class C ✓
- C Stage III (Localised), Host Class B
- D Stage IV (Diffuse), Host Class B
Explanation
Cierny-Mader anatomic stages: I = medullary (intramedullary source, haematogenous); II = superficial (involves only cortex, contiguous focus); III = localized (stable, full-thickness cortical segment); IV = diffuse (unstable, circumferential cortical involvement requiring stabilization). This patient has superficial cortical involvement with intact medullary cavity — Stage II. Host class: A = normal host; B = compromised locally (BL) or systemically (BS); C = poor systemic host where treatment risks > disease. Uncontrolled diabetes, smoking, and peripheral neuropathy are systemic compromise factors = Class C. Stage II, Host Class C is correct.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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