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Onion skin periosteal reaction is seen in osteosarcoma, [2] Ewing sarcoma and Langerhans cell histiocytosis. [3] In radiological images, onion skin periosteal reaction is seen as radiolucent areas along the multiple layers of dense bone. [4] The lucent areas may be occupied by tumors or inflammation.
Examples of periosteal reactive bone in selected specimens of Triceratops. A periosteal reaction can result from a large number of causes, including injury and chronic irritation due to a medical condition such as hypertrophic osteopathy, bone healing in response to fracture, chronic stress injuries, subperiosteal hematomas, osteomyelitis, and cancer of the bone.
Onion skin periosteal reaction; Osteopathia striata; Osteoporosis circumscripta; P. Pad sign; Palla's sign; ... Sunburst periosteal reaction; Superior triangle sign;
The proliferative reaction of bone can also create delicate laminations constituting the periosteal layers and giving the radiographic appearance of an onion peel. [10] Plain films add valuable information in the initial evaluation or screening.
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The advancing tumour displaces the periosteum away from the bone medulla. The displaced and now lateral periosteum attempts to regenerate underlying bone. This describes a periosteal reaction. [citation needed] The main causes for this sign are osteosarcoma, Ewing's sarcoma, eumycetoma, and a subperiosteal abscess. [3] [4]
The periosteal cells distal to (at the far end of) the fracture gap develop into osteoblasts, which form woven bone [citation needed] through bone resorption of calcified cartilage and recruitment of bone cells and osteoclasts. [4] The fibroblasts within the granulation tissue develop into chondroblasts which also form hyaline cartilage.
Hypertrophic osteoarthropathy is a medical condition combining clubbing and periostitis of the small hand joints, especially the distal interphalangeal joints and the metacarpophalangeal joints.