Physiologic periostitis

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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
  • 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

Skeletal scintigraphy

Normal uptake is observed in contrast there is high uptake in trauma .

Differential diagnosis

  • trauma/non-accidental injury
    • not symmetric, lucent fracture line, soft-tissue swelling
  • osteomyelitis
    • not symmetric, usually metaphyseal, soft-tissue swelling
  • Caffey disease (infantile cortical hyperostosis)
    • same age group, flat bone involvement, soft-tissue swelling