Abstract
Aim
Chronic osteomyelitis of long bones is one of the most severe complications in orthopedics. Different options exist for treatment of this disease, however there is still no generally accepted comprehensive protocol that could potentially guide us in each particular step. There are many classifications that were designed to help us to make clinical decision, however even the most widely used Cierny-Mader classification does not count more a half of factors, assessment of which is essential for choosing the best treatment plan. This fact may be explained by the complexity of the disease process, diversity of treatment options and multistage approach to the management of these patients. Therefore, the purpose of this study was to work out a treatment protocol and clinical classification system, which will improve final outcomes in patients with chronic osteomyelitis of long bones.
Method
Three orthopedic surgeons and one general surgeon who specialize on bone and joint infection independently of each other made a review of literature dedicated to the topic of chronic osteomyelitis. Each surgeon created a list of factors that are essential to assess for successful treatment of chronic osteomyelitis. After four lists were thoroughly matched and discussed, 10 most important factors were defined. Each surgeon proposed his own protocol of treatment, based on existent data and own experience. All four protocols were discussed and analyzed to come up with new the most comprehensive one. Therefore, the new protocol was created. After the list of factors and protocol were created, surgeons independently of each other defined the most important factors for every stage in the new protocol. Thus new multi-stage classification of chronic osteomyelitis (MSC-CO) was proposed.
Results
We have defined the most important factors influencing on the decision making process in treatment of chronic osteomyelitis of long bones. The new comprehensive protocol and multi-stage clinical classification were developed.
Conclusions
We assume, that the proposed tools may improve the results of chronic osteomyelitis treatment. However, the clinical trials should be conducted to assess the utility of new treatment protocol and MSC-CO in daily practice.
