• Acute osteomyelitis – present with bone
infection of sudden onset associated with
systemic illness . It develops rapidly over a
period of 7-10 days.
• It can be confirmed from blood culture or
culture from specimen.
• It is easier to treat and overall turns out better
than chronic osteomyelitis.
• Subacute osteomyelitis-insidious in onset ,
symptoms last for more than 2 weeks, no
systemic symptoms .
• Diagnosis of subacute osteomyelitis is difficult
due to absence of obvious signs of local
infection , absence of pyrexia and normal WBC
• Chronic osteomyelitis- infection had been
present for more than 3 months
⚫Staphylococcus aureus is responsible for
more than 90% of all bone and joint
⚫In immunosuppressed patients: H.influenza,
Mycobacterium, Fungal & Gram-negative
organisms are more commonly involved.
⚫In neonates: Group B streptococci is a
• Incidence in US population is 21.8/1lac/year
• Incidence has reduced with the introduction of
• However, there has been an increased risk of
osteomyelitis among Immunosuppressed
patients, newborns, alcoholics and drug
The blood flow through the metaphysis is slow
and turbulent creating a natural environment for
the proliferation of microbes
• INFANTILE PATTERN: The metaphyseal and
diaphyseal vessels penetrate the epiphyseal
plate. Metaphyseal infections can thus pass to
the epiphysis and then the joint.
• CHILDHOOD PATTERN: No metaphyseal blood
vessel penetrates the physis.The metaphysis
is affected in hematogenous osteomyelitis with
sparing of epiphysis and joints.
• ADULT : Metaphyseal vessels penetrate
the vanishing physis & anastomose with
the vessels at the subarticular end of the
bone. This explains increased incidence of
septic arthritis secondary to osteomyelitis
Four pathways of bone invasion:-
1) Hematogenous spread: Most common source
2) Spread from a contiguous source of infection:
Cutaneous, Sinus and Dental infections are
3) Direct implantation of infection: Usually
occurs as a result of direct penetrating injuries
or puncture wounds.
4) Postoperative infection: Contamination of
Implantationof organism in medullary tissue
Vascularand cellular Response
Infarction of Bone Hyperemia
Penetration of inflammatory process through endosteum &
Reaches the subperiosteal space
Loss of blood supply New bone formation
⚫SEQUESTRUM: Dead bonewhich is denser than
the surrounding bone resulting from the cortical
& medullary infarcts. It is the hallmark of active
⚫INVOLUCRUM: Periosteal new bonewhich is
formed in an attempt to wall off the infective
⚫CLOACAE: are defects in the involucrum which
allow the continued discharge (decompression) of
inflammatory products from the bone. Most
frequently associated with chronicosteomyelitis.
CLINICAL FEATURES of ACUTE
⚫AGE:- 2-12 years
⚫SEX:- Male predominance (3:1)
⚫Fever with chills, pain & swelling over the affected
part and extensive loss of limb function.
⚫Pre-existing infection, most commonly skin,
respiratory tract and genitourinary tract is seen in
⚫Femur is the m/c bone involved. Other common sites
are tibia,humerus & radius.
⚫In adults pelvis and vertebrae are most commonly
affected. In a person with DM bones of feet are
affected, most commonly the calcaneum
• Bone scan and MRI are most sensitive
modalities for detection of osteomyelitis
however conventional radiology should
always be the first imaging modality to start
with as it provides overview of the anatomy
and pathologic conditions of the bone and
soft tissues of the region of the interest.
• Sonography is the most useful in the
diagnosis of fluid collections, periosteal
involvement and surrounding soft tissue
1) PLAIN RADIOGRAPHS:
No plain film changes are seen in the early phase of
Only 5% of radiographs are positive in the early
course of the disease.
Most accurate means for early detection is a nuclear bone
The radiological latent period on a plain film is upto
10 days for extremities and 21 days for spinal
The plain film radiographic diagnosis is made on the
basis of abnormalities of soft tissue and bone.
SOFT TISSUE ALTERATIONS:
⚫Earliest radiographic signs involve the soft tissues
rather than the bone
⚫Seen within 3 days of bacterial contamination of
⚫Swelling of thedeep soft tissues usually around the
metaphysis may be the earliestsign.
⚫Elevation and displacement of fat planes.
⚫Obliteration of fat planes.
Early lesion is that of a moth-eaten or permeative
destructive pattern usually affecting the metaphysis.
Bone sequestrum formation appears 3-6 weeks after the
initial onset of symptoms.
The necrotic fragments retain their original radiographic
density. As a result, they appear more SCLEROTIC RELATIVE
TO THE ADJACENT OSTEOPENIC BONE.
Large involucrum may be seen which is composed of more
rapidly formed woven bone & is therefore LESS DENSE
Periosteal new bone formation may beof the
2)Laminated or lamellar pattern
A soft tissue component, subperiosteal abscess
and dense involucrum are more striking in infants
than in adults.
A:MOTH EATEN PATTERN
REGION OF DISTAL
RADIUS WITH SOLID
B&C: LYTIC LESION IN THE MEDIAL
METAPHYSIS OF DISTAL FEMUR WITH
PERIOSTEAL RESPONSE ON POSTERIOR
SURFACE OF DISTAL FEMUR.
1) Deep soft tissue swelling- earliest sign.
• Periosteal elevation- seen as a hyperechoic line
• Subperiosteal fluid collection.
• Cortical breech- seen as a focal defect in the
• Joint effusion
• Abscess or sinus tract formation in soft tissues
which are characteristic of acute osteomyelitis.
3) RADIONUCLIDE IMAGING:
• Most sensitive investigation fordetecting early
. Howeverspecificity is low.
• 99mTc-MDP, 99mTc-HMDP and Gallium 67 citrate
are the m/c used radionuclide agents.
• Indium 111 labelled WBC are more sensitive &
• Theaccretion of radionuclide in bone is related to
the blood flow and local bone turnover.
• On triple phase scans, it shows increased uptake of
“hot spots” on all phases.
• False-positive results are seen in degenerative
disease, healing fracture, soft tissue infection and
• Gallium scan may reveal abnormal
accumulation of radiotracer in patients who
has active osteomyelitis where Tc scan showed
decreased activity or cold lesions
• Gallium accumulation seems to correlate
more accurately with activity of osteomyelitis
than Tc uptake.
• Disadvantage of Gallium can’t distinguish
bone and soft tissue uptake clearly.
Three Phase/Triphasic Bone Scan
The first phase /nuclear angiogram/ flow phase.
• Serial scans are taken during the first 2 to 5 seconds
after injection of the Technetium-99m-MDP. This phase
typically shows perfusion to a lesion.
• Cellulitis shows uptake more in phase 1 and phase 2 scan,
but not in phase 3.
• Pathology that is more moderate to severe will show
more uptake in the first two phases.
• Pathology that is chronic or partially treated will be more
pronounced in the third phase of a triphasic scan.
The second phase/ blood pool phase
• Obtained 5 minutes after injection. This shows the
relative vascularity to the area.
• Areas with moderate to severe inflammation have
dilated capillaries, which is where the blood flow is
stagnant and the radioisotope can "pool".
• This phase shows areas of intense or acute
inflammation more definitively compared with the
The third phase, delayed phase
• Obtained 3 hours after the injection, when the
majority of the radioisotope has been metabolized.
• This phase best shows the amount of bone turnover
associated with a lesion.
avidly at the site of
local accumulation of
proteins that are
labelled in vivo.
⦿ The radiation dose is
higher and the image
4) COMPUTED TOMOGRAPHY:
⚫ Early detection of bonychanges
⚫Bettervisualization of axial skeletal involvement
⚫Betterdelineation of periosteal reaction and
⚫ Sequestra are shown as areas of dense or high
attenuation spicules of bone in areas of osteolysis.
⚫Cloacae, periostitis and soft tissue masses are
shown. These may enhancewith ivcontrast.
• Highlysensitive and specific.
• STIR is the best sequence forosteomyelitis.
• Lesions appear HYPOINTENSE on T1
weighted imagesand HYPERINTENSE on
T2 weighted images.
T1 -weighting T2 - weighting STIR
LOW SIGNAL LOW SIGNAL LOW SIGNAL
LOW SIGNAL BRIGHT VERY BRIGHT
VERY BRIGHT LESS BRIGHT LOW SIGNAL
LOW SIGNAL ENHANCING
BRIGHT VERY BRIGHT
Figure 8–8 This 13-year-old boy presented with fever, leukocytosis, and
severe left hip pain. (A) A T1-weighted coronal MR image of the pelvis
decreased signal in the bone marrow of the left femoral neck.
(B) A T2-weighted image demonstrates a left hip joint effusion and increased
signal (edema) within the left femoral neck. This represented a
combination of septic arthritis and osteomyelitis.
1) Chronic Osteomyelitis- most common
2) Acute pyogenic arthritis
3) Pathological fracture
4) Growth-plate disturbances- lengthening,
shortening and deformity of limb.
Septicemiaand metastatic abscess.
⚫FACTORS RESPONSIBLE FOR CHRONICITY-
1) General factors: nutritional status, vascular disease,
2) Local factors: foreign body, sinus
3) Virulence of organism
4) Treatment: delayed, inadequate, inappropriate or
non-compliance to treatment
5) Risk factors- prosthesis, penetrating trauma
⚫C/F:- chronic discharging sinus is m/c presenting
symptom, minimal pain, low grade fever, tenderness
⚫Tibia is most commonly involved
⚫May be associated with SAPHO syndrome
1) Increased density ( sclerosis) of bone
2) Thickening and irregularity of bone
3) Periosteal new bone
4) Areas of destruction
5) Dense sequestra
1) Acute exacerbations
2) Pathological fracture
3) Growth disturbances
4) Joint stiffness
5) MARJOLIN’S ULCER: squamous cell
carcinoma within a cloaca usually 10-25
years later & painless.
7) SAPHO SYNDROME : Synovitis, acne,
pustulosis , hyperostosis and osteitis.
• Defined as a localized form of suppurative
• C/F:- localized nocturnal limb pain, & relieved
• Staph. aureus is the m/c bacterial agent.
• Metaphysisof tubular bones.
• Distal tibia is m/c site. Othersare proximal
tibia, distal femur, fibula & distal radius.
FEATURES: A well
circumscribed area of
bonedestruction with a
surrounding zone of
• Usually > 1 cm
• A metaphyseal
sclerotic border marks
the tractof infection.
BRODIE ‘S ABSCESS OSTEOID OSTEOMA
Radiolucency >1cm. Radiolucent nidus <1 cm and may have
a target centre of calcification.
Enhances on only delayed isotope scan. Enhances centrally both on blood pool
and delayed scan due to central
MRI: The necrotic tissue does not
Penumbra sign is seen
MRI : The central vascular material will
have a brighter signal and
ARTERIOGRAM: Vascular Blush in the
radiolucent nidus confirms diagnosis.
• Found in the long
tubular bones with
fusiform thickening of
• Lesion is cortical with
& reactive new bone
• No bonedestruction
or sequestrum is
⚫Affected only in 2-4% of thecases of
⚫M/c involves the lumbar
⚫In ivdrug abusers, Cervical spine is
⚫C/F- backache(m/c), decreased motion,
⚫The age of the patient determines the location
and rate of spread and thus the radiological
⚫<20 years: vascular channels to the disc exist
and disc infection occurs before vertebral
⚫Decrease in disc height, paraspinal edema.
⚫Eventually vertebral end plate destruction
occurs creating patchy areas of osteolysis
throughout the vertebral body.
⚫ADULTS: initial focus occurs at anterior
vertebral endplate-radiolucent & irregular
⚫As the adult disc is avascular, the organisms
lodge adjacent to the subchondral plates and
involve the disc secondarily.
⚫Vertebral destruction & collapse occurs, with
soft-tissue paraspinal swelling.
⚫Intradiscal gas may be seen on CT in clostridia,
brucellosis, tuberculosis & streptococcal
• Soft tissue swelling-
In cervical spine infections: Widening of the
retropharyngeal & retrotracheal spaces.
In thoracic spine- Displacement of paraspinal
In lumbar spine- Paravertebral or psoas abscess
• Epidural abscess may occur.
• Osseous ankylosis may occur as a late sequelae
• SI JOINT INFECTION
Loss of articularcortex
Erosions of subchondral bone
CHILDHOOD INFLAMATORY DISCITIS
⦿Is a distinct entity from osteomylelitis of the
⦿Occurs from 1-16 yrs of age.
⦿Clinical presentation is similar to acute
osteomyelitis but less severe.
⦿Xray: latent period of 3-4 weeks.
⦿Disc space narrowing , fragmentation and
destruction of adjacent subchondral
⚫Reactive end plate sclerosis occursas
⚫Posteriorelements are spared.
⚫A mild spinal flexion deformity mayoccur
⚫MRI is the most sensitive technique.
Cortical destruction is seen on T1. Disc &
marrow inflammation is seen on T1,T2 and
• More common in children, Male predominance
⚫Monoarticular involvement- knee (50%), hip
and ankle are most common sites of
⚫Staph aureus is the commonest causative
⚫Others are:- gonococcus, H.influenza, E.
coli, pneumococcus, salmonella, brucella.
• High grade feverand malaise
• Erythema, swelling and pain overaffected
• Altered gait- if weight bearing jointsare
• Restricted rangeof movements
• LAB INVESTIGATIONS- raised ESR,
leucocytosis, positive blood or joint fluid
1) Displacementof juxta-articular fat-early sign
2)Waldenstrom’s sign- in arthritis of hip joint
3)Rapid narrowing of joint space followed by
complete loss within few weeks
1) Earliestsign is loss of normal subchondral cortical
2)Moth eaten destructive pattern in metaphysis
3)Laminated periosteal response
4)Completeankylosisof joint in laterstages.
Measurement from inferiorand medial surface of
acetabulum (Kohlers teardrop) to the medial
margin femoral head is taken.
A measurement of >11 mm ora differenceof >2 mm
compared with opposite hip is a positive sign.
TOM SMITH’S ARTHRITIS
• Septic arthritis of hip seen in infants.
• Osteomyelitis can rupture the metaphyseal cortex
enter the articulation and spread via the synovial
fluid to the epiphysis and subarticular bone.
• D/D- DDH.
• Bones that have metaphysis within the adjacent
joint capsule are predisposed to rapid
development of septic arthiritis
• Head of femur is completely destroyed by the
• C/F- unstable gait, affected leg is shorter & hip
movements are increased in all directions.
TUBERCULOSIS OF BONES
⚫ Radiographic changes are seen at presentation.
⚫ Accounts for 3% of all cases of extrapulmonary TB
⚫ Targets the hips, knees, spine
⚫ Spinal tuberculosis is most common, accounts for 50% all
skeletal TB cases
⚫ Metaphysis is commonly involved,when long bones are
⚫ There is no surrounding zone of sclerosis.
⚫ Sequestra are small and absorbed by granulation tissue.
⚫ Periosteal reaction is not a prominent feature.
• COMMON SITES: Hip
and knee joints.
• Joint widening
secondary to effusion.
• Soft tissue swelling.
• Marginal erosions.
• Destruction of cortical
Tuberculous arthritis of the knee joint. Frontal radiograph demonstrates periarticular osteopenia (black arrow), peripheral
osseous erosions (white arrow), and relative preservation of the joint space. A triad of radiologic abnormalities (Phemister
triad) consisting of periarticular osteoporosis, peripherally located osseous erosion, and gradual diminution of the joint
space suggests the diagnosis of tuberculosis
LATE FEATURES: Symmetrical narrowing of joint
Moth eaten osteolytic bone destruction.
Juxta articular osteoporosis
End stage is fibrous ankylosis of the joint.
1) Slow , insidious onset.
2) Severe Juxta articular
3) Slow and asymmetrical
Joint Space narrowing
4) Bony sclerosis
5) End Stage—fibrous
1) Acute presentation
2) Juxta articular
osteoporosis less severe
3) Early joint Space
4) Bony sclerosis common
5) Bony ankylosis.
UNUSUAL PRESENTATIONS OF
• CARRIES SICCA: Tubercular destruction of the
humeral head with multiple erosive defects.
• CYSTIC TUBERCULOSIS: Multiple, symmetric,
well defined lytic lesions of the appendicular
• POTTS PUFFY TUMOR: A tubercular calvarial
lesion forming a button sequestrum and
fluctuant cold abscess on the scalp.
• WEAVER’S BOTTOM: Tubercular involvement
of the subgluteal bursae allowing direct
extension to the ischial tuberosity.
⦿Spine is the most frequent site of skeletal TB.
⦿Radiological latent period 21 days.
⦿Most common site: lower thoracic and upper lumbar vertebrae.
GENERAL: Insidious onset with constitutional symptoms like low
grade fever, anorexia, weight loss and night sweats.
LOCAL:Back pain, tenderness, paraplegia or paraparesis, and kyphotic
or scoliotic deformities
Risk factors of spinal infections
Advanced age > 50
Intravenous drug abuse
Immunosuppression or immune deficiency
Long-term steroid administration
Previous TB infection
Types of spinal involvement
– Neural arch involvement only
– Spinal canal granulomas without bony
Involvement of posterior elements is
⚫ In the more common
⚫ Infection begins in the
⚫ Bone softensgets
⚫ anterior wedging or
⚫ Spreads under the
ligament to involve
Approx. 75% of infected individuals develop a soft tissue
⚫ PARA VERTEBRAL ABSCESS
CERVICAL : Retropharyngeal
THORACIC : Paravertebral & along ribs
LUMBAR : Psoas abscess
⚫ Commonly occurs in the psoas muscle “ cold abscess
”Known as cold abscess because forms slowly and does not
normally present with heat, inflammation or pain.
⚫ Paraspinal fistula which may form a communication with the chest
wall or pelvic floor
⚫ Left untreated, degeneration and inflammation of the vertebrae
Herniation into the cord space cord compression and cauda
equina(NEUROLOGICAL COMPLICATION ,more in thoracic (narrowest canal)
⚫ Kyphosis gibbous (severe kyphosis)
FEATURES OF POTT’S SPINE ON RADIOGRAPH
⦿ lytic destruction at the anterior subchondral endplate
⦿ Loss of disc height
⦿ Paraspinal swelling
⦿ Vertebral body collapse.
⦿ Obliteration of the disc.
⦿ Gibbus formation.
⦿ Biomechanical stress on the
uninvolved vertebral body caudal
to the gibbus leads to increase in
height : width ratio known as LONG
– Involvement of only one vertebral body
–Involvement of several vertebral bodies without intervertebral
– Bowing of rib cage secondary to collapse of multiple vertebral
– Destruction of lateral or posterior aspects of vertebral bodies
⚫ Demonstrates bone
destruction/erosions when x-
ray may be normal
⚫ Helps in better anatomic
⚫ Soft tissue findings
‐ Abscess with calcification
is diagnostic of spinal
TB; CT is excellent
modality to visualize soft
⚫ Evaluates areas such as C-V
junction, cervico-dorsal, sacrum
providing guidance for biopsy
• On contrast CT
• strong rim
Four patterns of
1) Fragmentary (most
4) Well-defined lytic
with sclerotic margins
CT also demonstrates:
⚫Disc space narrowing
Is the imaging modality of
Demonstrates early bone
marrow involvement/edema ,
spinal canal and neural
Soft tissue and intraosseous
abscess are well
demonstrated, but poorly
visualizes calcification in
T1WI : shows a decreased signal
within the affected vertebral
marrow along with loss of disc
Cortical definition of Vertebra is
Disc space narrowing is also
seen but limited to degree of
T2WI : shows an increase in
signal intensity within the
involved Vertebra and disc
Sagittal T2W (Images 1-3)and axial T1W (Image 4)
High intensity activity in T12 to L3 vertebrae indicative of infection (*) (*).
Complete destruction of
vertebral bodies with osseous retropulsion into the spinal canal, causing
cauda equina (*). On axial
view, note destruction of vertebral body with loss of circular shape(*).
⚫ Paraspinal soft tissue
masses ( seen in 71% of
⚫ T1WI :
⚫ Loss of uniform signal
⚫ Enlargement of affected
muscle alteration of
paraspinal soft tissue
⚫ T2WI :
⚫ Post–contrast :
⚫ Thick rim enhancement
and paraspinal soft
⚫ Also delineate
between vertebral and
Plain x-ray or CT: little
Cord involved by
compression or direct
extension of disease
– shows cord edema
or myelomalacia in
⚫Post treatment follow
up can be done ideally
⚫progressive increase in
signal intensity on
T1WI correlates well
enhancement is useful
sign of healing
⚫However, increase in
soft tissue mass , bone
destruction do not
⚫Is economical ,highly sensitive but non-
⚫Uptake is increased in osseous
⚫Reveals multiple sites in disseminated
⚫Have reported many false-negative
⚫Seen in disseminated TB, cervical spine
regions and neural arch lesions
⚫Limits the use of scintigraphy
1. Pyogenic infection :
– Often difficult
– Sudden onset with swinging temperature
– Rapid bone destruction and rapid disc
– Replaced by pronounced new bone
formation and sclerosis
– However,calcification indicates TB
2. Degenerative Spondylosis :
Clinical findings allow differentiation
Disc space is usually not markedly
T2WI : disc dessication is seen as low
3.Brucella Spondylitis :
H/O undulent fever
Lower lumbar vertebra are
Erosion of anterior upper or lower margins
Step like deformity or rounding-off the
4.Metastatic Deposits :
– Collapse of diseased vertebrae but
disc remains unaffected
– Involvement of other bones and
destruction of pedicles suggest
• Other D/D :
– Multiple myeloma , chordoma
– Primary bone tumors
– Lymphomas , sarcoidosis
– Bizzare infections :fungal, syphilitic ,
Features:- Tubercular Pyogenic
Dorsolumbar Lower lumbar
common Not common
May be involved Spared
Tubercular spondylitis Vs Pyogenic spondylitis
Features:- Tubercular Pyogenic
Disc destruction late early
Paraspinal mass large small
Spinal deformity common Uncommon
Bone sclerosis Absent present
• Chronic granulomatous
fungal disease affecting
• Caused by Nocardia
• Localized swelling ,
from sinus tracts.
• Osseous lesionsoccur
as a direct extension
from the soft tissues.
• Tarso-metatarsal region is
most commonly affected.
• Widespread lytic
destructive lesions with
filiform or undulating
• Fistula formation is
• Periosteal reaction is
• Sequestrum is
⚫In advanced cases, nearlyall bones of the footare
⚫Diffuse intraarticular ankylosis occurs as sequela.
⚫MRI FINDINGS: Generalized low signal intensity
of the matrix with lesions of high signal intensity
⚫Within these high signal intensity lesions, a low
intensity focus can be identified known as DOT
IN CIRCLE SIGN.
⚫This sign is highly specific for mycetomaof the
⚫It is an unusual suppurativebacterial infection. Infective
agents- Actinomyces israelii and bovis
⚫2 types- cervicofacial type (m/c) and chest & abdominal
⚫The mandible is the most commonly involved.
⚫Thecharacteristic feature is a lytic destructive lesion at
the angle of the mandible with little or no periosteal
⚫Abscess formation and draining sinuses are associated
with mandibular lesions.
⚫Other bones involved are ribs, spineand pelvis.
Osteolytic lesion with periosteal reaction of posterior body and ramus of
mandible with the soft tissue infiltrative changes in skin , messator muscle
and parotid gland
⚫Caused by Coccidioides immitis
⚫Skeletal involvement is secondary to respiratory
⚫Bone involvementoccurs in 20% of cases.
⚫Spine, pelvis, ribs and bony prominences such as tibial
tuberosity, malleoli, trochanters, acromion, patella &
olecranon are involved.
⚫Nocharacteristic radiological criteria.
⚫Bone lesions resemble theappearances of acute and
• SPINAL COCCIDIOIDOMYCOSIS:
Lucent lesions in vertebral body, pedicles &
Sparing of discspaces
CONTIGUOUS RIB INVOLVEMENT is
Paraspinal mass (abscess formation)
resent at birth or shortly
⦿ Spirochaetes are lodged
beneath the fetal growth
plates producing a
formation in the zone of
ossification is decreased
⦿ These bands lead to
with fragmentation and
infarctions referred as
⦿ WIMBERGERS SIGN:B/L
erosive defects on the
medial margin of the
• Phase1 lesions heal without therapywithin
• PHASE2:PERIOSTITIS:The periosteum is
infiltrated with syphilic granulation tissue
creating a diffuse,symemetrical,solid or
laminated reaction affecting all long bones.
• PHASE3:OSTEITIS:Infantswho have not
received therapycan developosteitis.
• Syphylitic granulation tissue can extend
from the metaphysis to the diaphysis
creating osteolytic lesions surrounded with
⦿ Anterior bowing of the
tibia with Extensive
contourto the long
bones (SABER SHIN).
⦿ osteolyticdefects can
also be seen
• CLUTTON’S JOINTS:
B/L painless synovitis of jointsespecially the
• HUTCHISON’S TEETH :
Deformityof the teeth creating peg shaped ,
hypoplasticand notched teeth.
• Fewer than 10% of the patients develop osseous lesions.
• Skeletal manifestations are seen in tertiary syphilis
• Superficial part of the skeleton which are the skull, tibia
and clavicles are usually involved.
• There is diffuse proliferative periostitis leading to
diffuse thickening of the inner and outer cortices.This
periosteal reaction is known as lace like pattern.
• Pseudobowing of tibia mayoccur.
• Syphilitic osteomyelitis may be localised(gumma) or
diffuse(gummatous osteitis). There is sclerosis with
irregularity of bone trabeculation.
⦿ OSTEITIS LEPROSA: Granulomas cause focal cortical and
medullary destruction.Small cysts are seen known as
OSTEITIS MULTIPLEX CYSTICA LEPROSA.
⦿ Bone loss may occur both longitudinally and
• This gives rise toa ‘ LICKED CANDY STICK’
• Diffuse non specific osteoporosis.
• Featuresof superimposed pyogenic osteomyelitis.