A review of the roentgenograms of 126 children with sickle-cell disease seen over a five-year period (1956–61) at Kings County Hospital Center (Brooklyn, N. Y.) disclosed several unusual skeletal changes which are the subject of this report. The changes to be emphasized here have been included in the excellent discussions of sickle-cell disease by Middlemiss (1) and by Moseley (2). In general, three types of bony abnormalities occur. Marrow hyperplasia, involving the long and short tubular bones and the axial skeleton, frequently results in the roentgen appearance of widened medullary cavities and intertrabecular spaces, with cortical thinning. A second type of osseous lesion results from infarction. The roentgen appearance due to this cause varies according to (a) the site and extent of infarction, (b) the degree of surrounding hyperemia, (c) the state of osteoclastic resorption and osteoblastic repair, and (d) the effect of weight-bearing on compromised bone. A third complication is osteomyelitis, particularly Salmonella osteomyelitis. The cases discussed in this paper exhibited unusual and interesting manifestations of these bony abnormalities. Report of Cases Case I: A colored boy, nine months of age, was first admitted to Kings County Hospital Center because of swelling and tenderness of both hands and feet for one week. His urine had been dark reddish brown for five days prior to admission, and he had fever to 103° for three days. Previously he had been in good health except for two forty-eight-hour episodes of slight swelling of the left wrist, at five months and at six months of age. On admission, the child was sitting in a cross-legged position, in acute discomfort. Tender nonpitting edema of both hands and feet was present. The liver and spleen were enlarged. Laboratory examination revealed the following data: hemoglobin 6.1 per cent, total red blood cells 2.58 million per cubic millimeter; hematocrit, 23 per cent; reticulocytes, 23.6 per cent; white blood cell count, 25,450 per cubic millimeter (neutrophils 54 per cent, band forms 5 per cent, lymphocytes 26 per cent, monocytes 14 per cent, myelocytes 1 per cent, and 18 normoblasts). The sickle-cell preparation was positive, and hemoglobin electrophoresis showed homozygous “S” hemoglobin. The icteric index was 10 units. Urinalysis was normal. The child continued to have fever of 100 to 101°. Roentgenograms of the hands, taken three days after admission, showed lytic areas in the metacarpals with subperiosteal new bone formation in those on the left (Fig. 1). Swelling of the hands and feet gradually subsided, and the child was discharged on the nineteenth hospital day. During the succeeding eight years, the patient has had twenty-four admissions to the hospital for sickle-cell crises. With one exception, these crises were characterized by severe pain in the arms, legs, or back, and in ten instances were associated with abdominal pain.