Subperiosteal New Bone

Kwon DS, Spevak MR, Fletcher K et al (2002) Physiologic subperiosteal new bone formation prevalence, distribution and thickness in neonates and infants. AJR Am J Roentgenol 179 985-988... 

Subperiosteal new bone formation 4-10 days 10-14 days 14-21 days... 

With the production of osteoid and its subsequent calcification and ultimate transformation into bone there is an increase in density along the fracture line. With impacted fractures and other fractures where the periosteum remains intact or little disturbed this may be the only evidence of inj ury and it is, therefore, a less valuable sign than subperiosteal new bone and fracture line clarity. Again, movement may inhibit or destroy endosteal callus and a fracture line may remain clearly visible after a bone has united by periosteal new bone. Endosteal soft callus... 

Fig. 11.10. Radiograph of the left shoulder shows a healing fracture of the tip of the acromion (curved arrow), the left proximal humeral metaphysis (arrowhead) and the associated subperiosteal new bone formation (arrows)...

Subperiosteal new bone formation Clavicle fractures Long bone shaft fractures Linear skull fractures... 

HA has been used, both in soluble and crosslinked forms, as a carrier for calcium phosphate particles to stimulate bone regeneration. In a subcutaneous implantation model, an injectable paste-like material, consisting of beta-tricalcium phosphate (P-TCP), methylcellulose, and HA, increased the half-life of the P-TCP particles and ultimately vascularisation of the implantation bed [99]. In a unilateral tibial defect model in rabbits, the same formulation promoted a significant increase in new bone volume fraction after one week however, by 4 weeks, there was no difference in bone formation compared to controls [100]. Similarly, medical grade HA of three different MW (900,000 - Artz 1,900,000 - Suvenyl and 6,000,000 - Synvisc) were evaluated as carriers for octacalcium phosphate granules in a mouse subperiosteal calvarial model [101]. The formulations with... 

Kleinman and co-workers have thrown new light on this classic metaphyseal lesion (CML) associated with abuse (Kleinman et al. 1986 Kleinman and Marks 1995,1996,1998). They have shown that the fundamental abnormality is a complete or incomplete transmetaphyseal fracture through the most immature metaphyseal primary spongiosa. Furthermore, as the fracture line passes peripherally towards the cortex it deviates away from the physis to undercut a thicker peripheral segment that encompasses the subperiosteal bone collar (Fig. 11.3). 

Fig. 67. From a partially vitamin C-deficient guinea pig. Frontal section of the proximal end of the fibular diaphysis, showing a microfracture and new subperiosteal bone developing in a widened cambial (cellular) layer of the periosteum.

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