Outcome of Two-Stage Treatment of Cierny/Mader Type III and IV Chronic Osteomyelitis of the Long Bones

Chronic osteomyelitis is still common in developing countries, with patients often presenting late due to complications arising from the disease. The surgical treatment poses a considerable challenge due to the relatively high incidence of recurrence. The Cierny and Mader two-stage method of surgical treatment is gradually evolving as a standard in the treatment of chronic osteomyelitis of the long bones. The objective of this study was to determine the outcome of treatment using this method. This was a prospective observational study with consecutive recruitment of patients with chronic osteomyelitis of the long bones who met the inclusion criteria from the 1st of August 2009–31st of July 2017. Thirty-three patients were recruited into the study with a median age of 16 years and a male-to-female ratio of 2.3:1. The median duration of symptoms before presentation was 24 months, with a mean duration of follow-up of 11.5 years + 1.5 SD. The left limbs were more commonly affected, the lesion was mono-ostotic in 93.4% of patients and poly-ostotic in 6.6%. All the patients underwent the Cierny/ Mader two-stage treatment. Recurrence occurred in only two patients, and Staphylococcus aureus remained the most common bacterial isolates. Outcome was successful in 93.4% (31/33) of the patients. Two-stage treatment of Cierny/Mader type III and IV chronic osteomyelitis of the long bones resulted in successful outcome in the majority of our patients. Therefore, this treatment can be successfully used in developing countries.