Question:hard
A patient with a history of road traffic accident 2 years back now develops pain and swelling at the same site. The X-ray shows the features below. What is the diagnosis?
A patient with a history of road traffic accident 2 years back now develops pain and swelling at the same site. The X-ray shows the features below. What is the diagnosis?
Show Hint
Old trauma site, late pain, layered sclerotic periosteal bone (Garre).
Updated On: Jun 24, 2026
- Osteogenic sarcoma
- Ewing's sarcoma
- Chronic osteomyelitis
- Multiple myeloma
Show Solution
The Correct Option is C
Solution and Explanation
Step 1: Anchor on the timeline: trauma two years earlier, then late pain and swelling at the identical spot. A slowly evolving lesion seeded by an old injury is far more typical of chronic infection than of an aggressive primary tumour.
Step 2: The radiographic clue described is dense, layered cortical thickening from periosteal new bone - the hallmark of Garre sclerosing (chronic non-suppurative) osteomyelitis, where mild ongoing infection triggers subperiosteal bone laydown in repeated layers. This sclerotic, onion-skinned, often asymptomatic-then-painful pattern confirms chronic osteomyelitis.
Step 3: Filter out the malignancies. Osteosarcoma shows aggressive sunburst spiculation and a Codman triangle, not smooth lamellae. Ewing sarcoma, although it may layer the periosteum, strikes young patients with a destructive moth-eaten lesion and fever, unrelated to prior trauma. Myeloma gives scattered punched-out lytic holes in the elderly. None matches a single sclerotic post-traumatic focus.
\[\boxed{\text{Chronic osteomyelitis}}\]
Step 2: The radiographic clue described is dense, layered cortical thickening from periosteal new bone - the hallmark of Garre sclerosing (chronic non-suppurative) osteomyelitis, where mild ongoing infection triggers subperiosteal bone laydown in repeated layers. This sclerotic, onion-skinned, often asymptomatic-then-painful pattern confirms chronic osteomyelitis.
Step 3: Filter out the malignancies. Osteosarcoma shows aggressive sunburst spiculation and a Codman triangle, not smooth lamellae. Ewing sarcoma, although it may layer the periosteum, strikes young patients with a destructive moth-eaten lesion and fever, unrelated to prior trauma. Myeloma gives scattered punched-out lytic holes in the elderly. None matches a single sclerotic post-traumatic focus.
\[\boxed{\text{Chronic osteomyelitis}}\]
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