Saturday, November 15, 2014

Types of sequestrum

Since there isn't a complete post on it online, I thought I'd write about it.

Tubular or diaphyseal sequestrum is seen in acute pyogenic osteomyelitis.

Ring sequestrum is seen in amputation stump and at Steinmann pins.

Ivory sequestrum is seen in syphilis.

Fine sandy sequestrum is seen in viral osteomyelitis.

Coarse sandy sequestrum is seen in out of cavity TB (for example, central body of vertebra)

Flake or Feathery sequestrum is seen in the cavity tuberculosis (for example, TB rib)

Kissing sequestrum is seen in peridiscal TB vertebra.

Button hole sequestrum is seen after radiation.

Coke sequestrum is seen in cancellous bone.
Bombay or black sequestrum is due to H2S & pollution.
Black sequestrum is also seen in actinomycosis.

That's all!
You are free to add more to the list, if you like :)

Update #1
Granular sequestrum is seen in Salmonella osteomyelitis.

Update #2
When the sequestrum is small and surrounded by lucent rim it is known as a button sequestrum. This is not seen only in osteomyelits, but also in eosinophilic granuloma, fibrosarcoma and lymphoma.
Since I got button and buttonhole sequestrum from different sources, I'm not sure if it's the same or not.

Update #3
Sequestrum can also be formed or unformed depending on whether separation from the normal bone has occurred or not.

Update #4: Sequestrum and involucrum mnemonic:
Sequestrum is the soul of the dead bone, dying sequestered alone.
Involucrum is the incoming new bone.


  1. I am using Maheshwari textbook-essential orthopaedics
    I only found diaphysis sequestrum here.I think there isn't a topic on viral osteomyelitis.If this post is from maheshwari book please provide page numbers.After a exhaustive search for 1/2 hr very little is found here

    1. I put together this list by searching on the internet myself.

      I didn't find anything in Maheshwari either. I don't blame them, it's very rare so they must've thought it's not important to mention it.

      FYI, causes of viral osteomyelitis are: Smallpox
      Intrauterine rubella
      Cytomegalic inclusion disease

      This is a good read on viral osteomyelitis:

  2. According to mahershwari, feathery sequestrum is seen in syphilis. Please confirm what's correct.


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