Sequestrum and its types

Sequestrum and its types

1. SEQUESTRUM AND ITS TYPES MODERATOR : DR ARUN H S PROFESSOR AND HOD DEPT OF ORTHOPAEDICS RLJALAPPA HOSPITAL KOLAR PRESENTER :TARUN SOMISETTY JUNIOR RESIDENT

2. LESSON PLAN Name of the lecturer:- Dr. Tarun Date:-12/7/2021 Time:-8 minutes Subject:- orthopedics Topic:- SEQUESTRUM AND ITS TYPES

3. SPECIFIC LEARNING OBJECTIVES At the end of the class all participants should be able to know: Definition of sequestrum Types of sequestrum Differential diagnosis of sequestrum

4. DEFINITION It is a separated, microscopic or macroscopic necrotic fragment of usually cortical bone and is surrounded by infected granulation tissue and pus from parent viable bone. The sequestrum is a preferable homing nidus for bacteria as systemic antibiotics cannot reach the necrotic bone, avascular tissue and pus filled cavity. Also new bone formation is inhibited by the sequestrum. They are identified by their ivory white color and brittle nature.

5. TYPES BASED ON SHAPE: Pencil like- infants Cylindrical/tubular- infants Ring- external fixator pins, schanz screws and ilizarov wires Cortical/ annular- amputation stump Trapezoid and irregular-adolescents Coralliform - perthes Flake like- tuberculosis Button sequestrum- calvarium

6. BASED ON CONSISTENCY: Coke like- tuberculosis Feathery- syphilis Sand like (coarse)- tubercular osteomyelitis in metaphysis Sand like (fine)- viral osteomyelitis

7. BASED ON COLOR: Black- amputation stump and long exposure of necrotic bone to air while attached to parent bone, fungal infection, actinomycosis . Green- pseudomonas osteomyelitis

8. IDENTIFICATION OF SEQUESTRUM To aid identification of nonviable tissue and sequestrum methylene blue can be injected through one of the communicating sinuses (identified on sinogram ). The dye stains viable tissue gray but non viable tissue appears blue. Alternatively dead tissue may be identified by preoperative injection of sulfous blue which will color all the tissues green, except the devitalized tissue which reamain uncolored.

9. SINOGRAM

10. SEQUESTRECTOMY sequestrectomy will remove not only the infective focus but also aid in quick healing and bone formation.

11. SEQUESTRECTOMY Removal of sequestrum If it lies within medullary cavity-removed by making window in overlying involucrum Wait for adequate involucrum to form before performing Sequestrectomy will remove not only infective focus but also aid in quick healing and bone formation

12. DIFFERENTIAL DIAGNOSIS Radiation necrosis Eosinophilic granuloma Metastatic carcinoma Primary lymphoma of bone Fibrous tumors of bone Mineralization of primary tumor of bone like osteoblastoma , osteoid osteoma , chondroblastoma , fibromyxoma .

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