Chronic Osteomyelitis

Question 1

What is sequestrum

Answer 1

A piece of dead born surrounded by infected granulation tissue trying to eat the sequesterm away.
It appears pale and has has smooth inner and rough outer surface because the outer surface is being constantly eroded by the surrounding granulation tissue.
Different types of sequestrum - tubular in pyogenic, ring in external fixator, black in actinomycosis, coke and Sandy in tuberculosis

Question 2

Radiological changes of sequestrum

Answer 2

It appears denser than the surrounding normal bone because they calcification which occur in normal bone does not occur in dead bone.
Granulation tissues surrounding the sequestion give rise to radiolucent zone around it.
Sequesterum maybe visible in soft tissues.

Question 3

Treatment of sequestrum

Answer 3

Sequesterectomy -removal of sequesterm.
If it lies within the medal cavity a window is made in the overlying involucrum and sequestrum removed. Wait for adequate involucrum formation before performing sequestectomy.

Question 4

Complications of chronic osteomyelitis

Answer 4

1. Acute exacerbation
2. Growth abnormalities
3. Pathological fracture
4. Joint stiffness
5. Sinus tract malignancy(SCC)
6. Amyloidosis

Question 5

Different growth abnormalities

Answer 5

Growth disturbance at adjacent growth plate in one of the following ways

1. Shortening when the growth plate is damaged
2. Lengthening because of increased vascularity of the growth plate due to nearby osteomyelitis.
3. Deformity due to damage of part of growth plate.