. Roentgen interpretation; a manual for students and practitioners . r conditions. Itattacks any bone at any age. Its commonest manifestations areperiostitis and irregular areas of destruction. Periostitis is usually limited to the shaft, and the picture whichresults from it varies according to the age and activity of theprocess. ^Yhen acute the appearance is that of multiple distinct,thin laminse laid do^^m upon the old cortex, and the outline of thefree margin is usually irregular. As the condition becomes morechronic these laminae become thicker and more compact, so that 58 BONE PATHOLOGY u
. Roentgen interpretation; a manual for students and practitioners . r conditions. Itattacks any bone at any age. Its commonest manifestations areperiostitis and irregular areas of destruction. Periostitis is usually limited to the shaft, and the picture whichresults from it varies according to the age and activity of theprocess. ^Yhen acute the appearance is that of multiple distinct,thin laminse laid do^^m upon the old cortex, and the outline of thefree margin is usually irregular. As the condition becomes morechronic these laminae become thicker and more compact, so that 58 BONE PATHOLOGY ultimately the area involved becomes as dense as the normal the same time the surface loses its fringy character and becomessmooth, although it may be more or less irregular. This increase inthickness of the cortex will often give an appearance of bowing, as isseen in the so-called sabered tibia, for example. It should be notedthat this thickening of the cortex usually occurs on the convexside of the curve as compared with rickets, where it appears on the. Fig. 35.—Congenital syphilis (periosteal type). concave side. There is often an accompanying endosteal prolifera-tion with narrowing of the medullary canal. Periostitis may also occur as small local elevations of the perios-teum (bone blisters) at times near the ends of the long bonesand assumes the form of multiple confluent small blisters. There isanother type of lesion, a sort of lacework pattern, which consists ofstrands of calcified material which run out at right angles to thecortex and arch together at their terminations. Running through SYPHILIS 59 this pattern, parallel to the shaft and midway between the cortexand the periphery, there is a definite thin sheet of the margins of the process where it blends into the normal boneis the usual type of laminated periosteal thickening. In the con-genital form in infants the periosteum may be floated away from theshaft for a considerable distance,
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