Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
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Case Report

Volume 3, Number 1, February 2012, pages 7-11

A Case of Sequester and Involucrum Formation of the Fibula


Figure 1.
Figure 1. X-ray of the fibula of our patient at initial presentation without signs of osteomyelitis.
Figure 2.
Figure 2. X-ray of the fibula 8 weeks after the onset of symptoms showing periostal reaction and partial lysis and interruption of the fibula.
Figure 3.
Figure 3. CT image of our patient which shows osteomyelitis and partial interruption of the cortex of the fibula and periostal reaction with new bone formation. No sequester was described.
Figure 4.
Figure 4. MRI image of our patient with extreme periostal reaction and extensive soft-tissue abnormalities with intramuscular abscess formation.
Figure 5.
Figure 5. Sequestrum incorporated by an involucrum of the fibula.
Figure 6.
Figure 6. Removed sequestrum of the fibula.


Table 1. Cierny-Mader Classification System of Adult Osteomyelitis [12]
Anatomic typePhysiologic host
1: Medullary osteomyelitis.
  Nidus is endosteal.
A: Normal host/immune system/vascularity.
2: Superficial osteomyelitis.
  Limited to the surface of the bone.
B: Bs systemic compromise.
  B1 local compromise.
  Bs1 systemic and local compromise.
3: Localized osteomyelitis.
  Full thickness of the cortex is involved.
C: Treatment morbidity worse than present condition.
4: Diffuse osteomyelitis.
  Entire circumference involvement.