Physiologic periostitis

Last revised by Joshua Yap on 29 Feb 2024

Physiologic periostitis describes the normal presence of smooth bilateral diaphyseal periosteal new bone in the humeri, femora, or tibiae of infants aged 1 to 6 months. It can be observed in both preterm and term infants. The etiology is unclear but may simply relate to rapid growth.  

Radiographic features

  • long bones: tibiae, humeri, and femora relatively equally affected

  • diaphyseal smooth periosteal reaction which may extend partly into the metaphyseal region, but not to the end of the metaphysis

  • always bilateral and usually symmetric in extent 

  • organized and lamellar 2

  • often concentric around the bone but may predominate on one aspect

  • when tibial, it is always seen along the medial aspect

  • no fracture or metaphyseal corner lucency

  • no flat bone involvement

Nuclear medicine
Bone scan

Normal uptake is observed. In contrast, there is high uptake in trauma 2.

Differential diagnosis

  • trauma / non-accidental injury: asymmetric, lucent fracture line, soft-tissue swelling

  • osteomyelitis: asymmetric, usually metaphyseal, soft-tissue swelling

  • Caffey disease (infantile cortical hyperostosis): same age group, flat bone involvement, soft-tissue swelling  

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