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Updated: May 1, 2025
The edges and deep surface of the sequestrum present a serrated or worm-eaten appearance due to the process of erosion by which the dead bone has been separated from the living. The most important diseases in this group are the pyogenic, the tuberculous, and the syphilitic.
The periosteum, which is thick and easily separable, is raised from the new case with an elevator, and with the chisel or gouge enough of the new bone is taken away to allow of the removal of the sequestrum. Care must be taken not to leave behind any fragment of dead bone, as this will interfere with healing, and may determine a relapse of suppuration.
Less frequently the trabecular framework is added to by the formation of new bone, resulting in a remarkable degree of sclerosis, and if, following upon this, there is caseation of the tubercle and death of the affected portion of bone, there results a sequestrum often of considerable size and characteristic shape, which, because of the sclerosis and surrounding endarteritis, is exceedingly slow in separating.
In the macerated specimen, the sequestrum appears small in proportion to the large cavity in which it lies. All these changes are revealed in a good skiagram, which not only confirms the diagnosis, but, in many instances, demonstrates the extent of the disease, the presence or absence of a sequestrum, and the amount of new bone on the surface.
The commonest sequel is the presence of a sequestrum with one or more discharging sinuses; owing to the abundant formation of scar tissue these sinuses have rigid edges which are usually depressed and adherent to the bone. The Recognition and Removal of Sequestra.
An isolated gumma forms a firm elastic swelling, shading off into the surroundings. If the overlying skin is destroyed and septic infection superadded, such an isolated area of bone is apt to die and furnish a sequestrum; the separation of the dead bone is extremely slow, partly from the want of vascularity in the sclerosed bone round about, and partly from the density of the sequestrum.
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