TABLE 11: Some terms and definitions related to chronic

osteomyelitis
Sequestrum: It is a separated, microscopic or macroscopic necrotic fragment of
usually cortical bone (which appears radiodense on X-ray) and is surrounded
by infected granulation tissue and pus (radiolucent) from parent viable bone.
Types of sequestrum
• Shape
Pencil like-infants
Cylindrical/tubular-infants
Ring-external fixator pins, Schanz screws and llizarov wires
Conical-amputation stump
Annular-amputation stump
Trapezoid and irregular-adolescents
Coralliform-Perthes
Flake like-tuberculosis
Button sequestrum-calvarium
• Consistency
Coke like-tuberculosis
Feathery-syphilis
Sand like (coarse)-tubercular osteomyelitis in metaphysis
Sand like (fine)-viral osteomyelitis
• Colored
Black-amputation stump and long exposure of necrotic bone
to air while also attached to parent bone (formation of ferrous
sulfide), fungal infection, actinomycosis
Green-pseudomonal osteomyelitis
Differential diagnosis of sequestrum: Radiation necrosis, eosinophilic
granuloma, metastatic carcinoma, primary lymphoma of bone, fibrous tumors
of bone. Mineralization in primary tumor of bone like osteoblastoma, osteoid
osteoma, chondroblastoma, fibromyxoma and desmoplastic fibroma.
lnvolucrum (involucre-wrapping, cover): It is a su bperiostea I, reactive, viable,
immature (woven) new bone formation around a dead bone. It has a rough
inner and smooth outer surface.
Differential diagnosis of involucrum: Physiologically seen in infants,
neuroblastoma, metastatic leukemia, hypervitaminosis A.
Cloacae:These are single or multiple openings in involucrum that serve as pus
discharging sites from the reactive bone. Small sequestrate are also extruded
through these holes. They are NOT sites of entrance of vessels.