Periostitis Ossificans: Largest Case Series with Review of Literature

Background  Periostitis ossificans (PO) are rare, benign ossifying surface lesions characterized by the centripetal ossification with osseous and soft-tissue edema. Their clinicoradiological appearances can easily mimic those of more sinister or infective surface lesion. Objective  This study aimed to explore the various anatomical locations and muscle attachment at the site of PO, and evaluate the role of complementary image findings in patients presenting at our tertiary orthopaedic referral center. Patients and Methods  A retrospective review of our oncology and radiology databases was undertaken to identify patients with PO reported on radiographs, magnetic resonance imaging (MRI) and computed tomography (CT) over the past 13 years (2007-2020). Patient demographics, sites of PO, muscle attachment at the site of PO, findings on complementary imaging, and clinical management outcome were documented. Results We identified 38 patients with PO with a mean age of 24 years (range: 4-66 years). Muscle attachment was seen at the site of PO in the majority of cases (89%). The majority of PO were in the lower limb and commonly seen around the attachment of quadriceps. Deltoid attachment was commonly involved in the upper limb. Conclusion  Muscle attachment is commonly seen at the site of PO, which results in stripping of the periosteum resulting in soft-tissue and osseous edema and centripetal ossification.