The infection may remain focussed in a discrete region, or more commonly spread along the shaft of a long bone.
Necrotic bone is found in cavities - sequestrum - containing pus and walled of with vascular tissue and sclerotic new bone - involucrum.
The sequestrum acts as a haven for bacteria, permitting continued infection until the bone is passed through a draining sinus or removed surgically.
The infection may follow a relapsing and remitting course; the sinuses may close off for weeks or months, only to reopen as pus reaccumulates.
The sclerotic involucrum is more brittle than normal bone and is liable to pathological fractures.
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