Periosteal reactions in pediatrics.

Abstract

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