Question

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. Osteogenic sarcoma
• B. Ewing's sarcoma
• C. Chronic osteomyelitis
• D. Multiple myeloma

Hint:

Old trauma site, late pain, layered sclerotic periosteal bone (Garre).

Answer 1

The Correct Option is C

Step 1: The history of a previous injury at the same site followed years later by pain and swelling, together with the radiograph, points to a chronic bone infection rather than a fresh tumour. This is the picture of Garre sclerosing osteomyelitis, a form of chronic non-suppurative osteomyelitis.
Step 2: In Garre osteomyelitis low-grade inflammation stimulates subperiosteal bone deposition. The X-ray shows periosteal proliferation surrounded by successive layers of dense cortical bone, giving the classic onion-skin layering. Because the bone is reactive and the process is indolent, the diagnosis is chronic osteomyelitis.
Step 3: Why the others are wrong. Osteogenic sarcoma produces a sunburst pattern and Codman triangle, not orderly concentric layers. Ewing sarcoma can also give onion-skin periosteal reaction, but it is a tumour of young children with a permeative lytic lesion and systemic features, not a sequel to old trauma. Multiple myeloma causes multiple punched-out lytic lesions in older adults, which does not fit this localized post-traumatic lesion.