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Case report
Physiological periostitis; a potential pitfall
  1. P de Silva,
  2. G Evans-Jones,
  3. A Wright,
  4. R Henderson
  1. Paediatrics, Countess of Chester Hospital NHS Trust, Chester, UK
  1. Correspondence to:
    Dr G Evans-Jones
    Women’s and Children’s Directorate, The Long House, Countess of Chester Hospital NHS Trust, Countess of Chester Hospital Health Park, Liverpool Road, Chester CH2 1UL, UK; gareth.evans-jonescoch.nhs.uk

https://doi.org/10.1136/adc.88.12.1124

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    Physiological periostitis is a known radiological finding in infants aged between 1 and 6 months. Two children with physiological periostitis mistaken for non-accidental injury are described. In both these patients only one limb was imaged and failure to image the contralateral limb led to unnecessary skeletal survey and distress for the families.

    CASE 1

    A 3 month old infant was admitted with a 24 hour history of reluctance to move her right leg. There was no history of trauma, fever, or malaise. A radiograph of the right leg was reported to show a periosteal reaction at the lateral aspect of the femur consistent with a fracture. The parents could not explain the suspected injury and a Child Protection investigation was done which found no pointers to abuse. A skeletal survey showed no other fracture but a similar appearance in the corresponding area of the left femur leading to a revised diagnosis of physiological periostitis1 (fig 1). The infant’s symptoms did …

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