Diaphyseal Sequestrum

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Information about Diaphyseal Sequestrum
Health & Medicine

Published on November 24, 2007

Author: naneria

Source: slideshare.net

Description

chronic osteomyelitis with diaphyseal sequestration, time line, healing, reconstruction

Chronic Osteomyelitis Diaphyseal Sequestrum Vinod Naneria Consultant Orthopaedic Surgeon Choithram Hospital & Research Centre, Indore India

Diaphyseal Sequestrum Usually a very large piece of diaphysis. Takes long time to separate from main bone. Involucrum forms slowly & usually incomplete. Sequestractomy is required. Post surgery some protection is necessary. End result is always good.

Usually a very large piece of diaphysis.

Takes long time to separate from main bone.

Involucrum forms slowly & usually incomplete.

Sequestractomy is required.

Post surgery some protection is necessary.

End result is always good.

Tips & Tricks Time line 6 months to 1 year. Culture and sensitivity. Antibiotics 2 days before surgery. A sinogram or CT Scan for clear demarcation. Methylene Blue can be used. Surgery under X-ray or CCTV control. Protection from re-fracture by splints.

Time line 6 months to 1 year.

Culture and sensitivity.

Antibiotics 2 days before surgery.

A sinogram or CT Scan for clear demarcation.

Methylene Blue can be used.

Surgery under X-ray or CCTV control.

Protection from re-fracture by splints.

Case One 10 years old Male child Acute osteomyelitis rt. Femur lower shaft Tx at Primary health centre in a village Developed a long diaphyseal sequastrum. The sequestrum was removed when involucrum was adequate. Final healing

10 years old Male child

Acute osteomyelitis rt. Femur lower shaft

Tx at Primary health centre in a village

Developed a long diaphyseal sequastrum.

The sequestrum was removed when involucrum was adequate.

Final healing

Case studies Case 1 : classical example. Case 2 : required post surgery protection. Case 3 : early age, rapid involucrum, small sequestra absorption, joint dislocation. Case 4: extrusion of the diaphysis, absoption of whole shaft, reconstruction by fibula thrice harvested from the same location.

Case 1 : classical example.

Case 2 : required post surgery protection.

Case 3 : early age, rapid involucrum, small sequestra absorption, joint dislocation.

Case 4: extrusion of the diaphysis, absoption of whole shaft, reconstruction by fibula thrice harvested from the same location.

Initial X-ray

Soft tissue showing pus collection

Periosteal Reaction all along the shaft

Diaphyseal Sequestrum Demarkation

Involucrum formation in progress

Involucrum is still incomplete

Complete healing After removal of Diaphyseal sequestrum

Summary

Case two A 12 years old male presented late with diaphyseal sequestrum. A seperation / fracture develop at the proximal end. Prolonged immobilization in Toe-to-groin cast. Sequestractomy was done after involucrum formation. Complete healing

A 12 years old male presented late with diaphyseal sequestrum.

A seperation / fracture develop at the proximal end.

Prolonged immobilization in Toe-to-groin cast.

Sequestractomy was done after involucrum formation.

Complete healing

Diaphyseal Sequestrum

Developing separation

Sequestrum in the process of separation

Dressing through window

Sufficient involucrum

 

Diaphyseal Sequestrum removed Additional protection provided by Skeletal traction in Thomas Splint.

Healing under Progress.

Complete Healing

Case three Acute osteomyelitis in a 3 years old child. Complete diaphyeal sequestration with multiple cloacae and sequestra. Observation & immobilization Rapid involucrum formation with absorption of small sequestra.

Acute osteomyelitis in a 3 years old child.

Complete diaphyeal sequestration with multiple cloacae and sequestra.

Observation & immobilization

Rapid involucrum formation with absorption of small sequestra.

Acute Osteomyelitis

Whole shaft involvement With dislocation of Hip & absorption of capital epiphysis

Rapid involucrum formation

Dislocated hip Diaphyseal sequestrum Complete involucrum

Case four Post BCG acute osteomyelitis of humerus in an infant Diaphyseal sequestration and extrusion before the involucrum formed. Absorption of the remaining shaft leaving a long gap between shoulder and elbow. Reconstructed by Fibula three times harvested from the same site.

Post BCG acute osteomyelitis of humerus in an infant

Diaphyseal sequestration and extrusion before the involucrum formed.

Absorption of the remaining shaft leaving a long gap between shoulder and elbow.

Reconstructed by Fibula three times harvested from the same site.

Post BCG acute osteomyelitis of humerus in an infant

Reconstruction by fibula and a thin K-wire second time

Wire broke but part of the Fibula was incorporated giving length to proximal & distal stumps.

After two years

After three years

 

Third time fibula grafting

 

 

 

 

References Chronic Osteomyelitis in Children David A. Spiegel, M.D.* and John Norgrove Penny, M.D., F.R.C.S.(C)† Techniques in Orthopaedics® 20(2):142–152 © 2005 Lippincott Williams & Wilkins, Inc., Philadelphia Natural course of Hematogenous Pyogenic Osteomyelitis Kharbanda Y; Dhir R S., J. Postgraduate Medicine, 1991, 37(1): 69-75. sequestra in chronic haematogenous osteomyelitis . Jain AK, Sharma DK, Kumar S, et al. Incorporation of diaphyseal Int Orthop 1995;19:238 –241. Reincorporation of earlydiaphyseal sequestra and bone remodelling in extensive haematogenous osteomyelitis in children , Varma BP, Tuli SM, Srivastava TP, et al, Indian J Orthop 1974;8:39–44.

Chronic Osteomyelitis in Children

David A. Spiegel, M.D.* and John Norgrove Penny, M.D., F.R.C.S.(C)† Techniques in Orthopaedics® 20(2):142–152 © 2005 Lippincott Williams & Wilkins, Inc., Philadelphia

Natural course of Hematogenous Pyogenic Osteomyelitis

Kharbanda Y; Dhir R S., J. Postgraduate Medicine, 1991, 37(1): 69-75.

sequestra in chronic haematogenous osteomyelitis .

Jain AK, Sharma DK, Kumar S, et al. Incorporation of diaphyseal Int Orthop 1995;19:238 –241.

Reincorporation of earlydiaphyseal sequestra and bone remodelling in extensive haematogenous osteomyelitis in children , Varma BP, Tuli SM, Srivastava TP, et al, Indian J Orthop 1974;8:39–44.

DISCLAIMER Information contained and transmitted by this presentation is based on personal experience and collection of cases at Choithram Hospital & Research centre, Indore, India, during last 25 years. It is intended for use only by the students of orthopaedic surgery. Views and opinion expressed in this presentation are personal opinion. Depending upon the x-rays and clinical presentations, viewers can make their own opinion. For any confusion please contact the sole author for clarification. Every body is allowed to copy or download and use the material best suited to him. I am not responsible for any controversies arise out of this presentation. For any correction or suggestion please contact [email_address]

Information contained and transmitted by this presentation is based on personal experience and collection of cases at Choithram Hospital & Research centre, Indore, India, during last 25 years.

It is intended for use only by the students of orthopaedic surgery.

Views and opinion expressed in this presentation are personal opinion.

Depending upon the x-rays and clinical presentations, viewers can make their own opinion.

For any confusion please contact the sole author for clarification.

Every body is allowed to copy or download and use the material best suited to him. I am not responsible for any controversies arise out of this presentation.

For any correction or suggestion please contact

[email_address]

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