Ulcer osteoma and periosteal reactions to chronic leg ulcers

• Published in: American journal of roentgenology (1976) Vol. 168; no. 1; pp. 155 - 157
• Main Authors: KARASICK, D, SCHWEITZER, M. E, DEELY, D. M
• Format: Journal Article
• Language: English
• Published: Leesburg, VA American Roentgen Ray Society 1997
• Subjects: Biological and medical sciences; Chronic Disease; Diseases of the osteoarticular system; Female; Fibula - diagnostic imaging; Fibula - pathology; Humans; Leg Ulcer - complications; Male; Medical sciences; Middle Aged; Miscellaneous. Osteoarticular involvement in other diseases; Osteomyelitis - diagnosis; Periosteum - diagnostic imaging; Periosteum - pathology; Periostitis - diagnosis; Periostitis - diagnostic imaging; Periostitis - etiology; Radiography; Retrospective Studies; Tibia - diagnostic imaging; Tibia - pathology; Human; Skin disease; Surface reaction; Periosteum; Diseases of the osteoarticular system; Radiologic investigation; Lower limb; Nuclear magnetic resonance imaging; Leg; Result; Radiography; Chronic; Medical imagery; Complication; Ulcer; Osteoid osteoma; Benign neoplasm; Bone
• ISSN: 0361-803X; 1546-3141
• DOI: 10.2214/ajr.168.1.8976939

The purpose of this study was to describe the types of periosteal reaction seen in response to long-standing leg ulcers and to differentiate the types associated with osteomyelitis. Over a 10-year span, we retrospectively evaluated the radiographs of 20 patients with lower leg soft-tissue ulceration and adjacent periosteal bone reaction of the tibia or fibula. Two of us evaluated the location and appearance of periosteal reaction, and one of us evaluated the patients' medical records for evidence of peripheral vascular disease, systemic illnesses, and osteomyelitis. Twelve patients had organized periosteal reactions that resulted in the appearance of ulcer osteoma. None of these patients subsequently developed osteomyelitis. Eight patients had interrupted lamellar nodular periosteal reactions; six of the eight patients had superimposed osteomyelitis. Our study showed two types of periosteal response to chronic leg ulcers: a solid organized type that over time formed an ulcer osteoma and a lamellar nodular type that was often associated with osteomyelitis. Both types of ulcers were seen in patients with peripheral vascular disease, IV drug abuse, sickle cell disease, and neurologic impairment.