Both upper extremities: There is periostitis involving the diaphysis and metaphysis of both humeri, radii and ulnae. There is also lucency along the metaphyseal region. This constellation of findings is consistent with the provided history of congenital syphilis. There is no evidence of pathologic fracture.
Both lower extremities: The examination is limited as no true AP view was performed secondary to patient positioning. There is periostitis involving the diaphysis and metaphysis of both femurs, tibias and fibulas. There is lucency along the metaphysis consistent with the provided history of congenital syphilis. Detailed evaluation of the tibial metaphysis is limited secondary to patient positioning. Therefore, the presence of erosions along the proximal tibia (Wimberger sign) cannot be assessed. There is no evidence of pathologic fracture.