Background: Childhood hematogenous chronic osteomyelitis remains a serious cause of morbidity throughout the developing world. The aim of our study was to develop a reliable and clinically useful classification system for this condition in children.
Methods: The case notes and radiographs of 87 children with chronic hematogenous osteomyelitis of one or more long bone were reviewed to devise a classification system. We undertook reliability studies of the proposed classification system. Five observers classified the selected radiographs of 32 patients on two separate occasions.
Results: The classification divides the condition into 3 main types: type A--Brodie's abscess, type B--sequestrum involucrum, and type C--sclerotic. Type B has four subtypes. Intraobserver agreement was 95% for the main types and 77% (kappa coefficient 0.7) with the subtypes. Interobserver agreement was 95% to 97% for the main types and 78% (multirater kappa=0.54) for the subtypes.
Conclusions: The results suggest that our classification system for chronic hematogenous osteomyelitis in children is reliable.