Kakarla Subbarao

Case Report 228

Fig. 1A, B. Posteroanterior and oblique views of the left index finger show a spindle-shaped, soft tissue swelling around the proximal phalanx, with a diffuse, permeative, lytic lesion affecting the entire proximal phalanx. Some of the smaller lytic areas in the proximal half of the bone coalesce into a large lytic lesion distally. Thickening of bony trabeculae with slight reactive sclerosis is present. The bone is larger than normal with thinning of the cortex and expansion of the medullary cavity and spongiosa. Periosteal reaction is not present. The density in the soft tissues noted in the oblique view is an artefact

Periosteal reactions in pediatrics

The periosteum normally is not identified radiologically due to lack of mineral content. It consists of an outer membranous layer and an inner cambium layer. The latter is replete with osteoblasts and osteoclasts and thus possesses the faculties of deposition and resorption of bone. Periosteum protects from minor stimuli but may swell, crack or ulcerate under stress and yet heal perfectly well and rarely tbrms keloid. Any external or internal stimulus, e.g. trauma, infection, metabolic process and neoplasm may induce periosteal reaction. The periosteum envelops the cortex and is relatively loose in the diaphyses of long bones, particularly in children. The periosteum blends intimately with the cortex towards the ends of long bones. While periosteal reaction is easily manifest in tubular bones, the cuboidal bones, e.g. carpus and flat bones, e.g. calvaria, manifest infrequently. Periosteal reaction is a radiological findings and represents subperiosteal calcification and ossification. Growth spurt may produce physiological periosteal reaction in infants, particularly below the age of six months in a symmetrical fashion along tubular bones (Fig. 1), but, as a

Fractures and dislocations around the adult knee

HE KNEE JOINT has evolved into a highly specialized structure in the human, surpassing that of all lower animals in its complexity. The cause lies in the excessive functional demands made on the human knee as a result of man’s erect posture. Weight-bearing, walking, running, and the ability to extend the knee completely are physiologic functions that subject the human knee to considerably more stress than in four-legged mammals. The knee, the largest joint in the body, is in a vulnerable position for direct trauma and unusual torsional and bending stresses. The security of the knee depends mostly on the powerful ligaments that bind the osseous components together, as well as on the muscles that surround it. Increasing participation in various sports activities has subjected more and more individuals to greater stress and severe injury of the knees than ever before.