Sequestrum and its types

Sequestrum and its types

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  SEQUESTRUM AND ITSTYPES MODERATOR : DR ARUN H S PROFESSOR AND HOD DEPT OF ORTHOPAEDICS RLJALAPPA HOSPITAL KOLAR PRESENTER :TARUN SOMISETTY JUNIOR RESIDENT
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  LESSON PLAN • Nameof the lecturer:- Dr. Tarun • Date:-12/7/2021 • Time:-8 minutes • Subject:- orthopedics • Topic:- SEQUESTRUM AND ITS TYPES
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  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
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  DEFINITION • It isa 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.
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  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
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  BASED ON CONSISTENCY: •Coke like- tuberculosis • Feathery- syphilis • Sand like (coarse)- tubercular osteomyelitis in metaphysis • Sand like (fine)- viral osteomyelitis
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  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
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  IDENTIFICATION OF SEQUESTRUM • Toaid 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.
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  SINOGRAM
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  SEQUESTRECTOMY • sequestrectomy willremove not only the infective focus but also aid in quick healing and bone formation.
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  SEQUESTRECTOMY • Removal ofsequestrum • 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
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  DIFFERENTIAL DIAGNOSIS • Radiationnecrosis • 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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  THANK YOU