Chapman

Question 1

Hypertrophic osteoarthropathy
Primary

Answer 1

Pachydermoperiostosis

Autosomal dominant
Children
Mild pain

Question 2

HPOA
Secondary causes

Answer 2

Most common

1. Lung cancer—>60% of cases.
2. Bronchiectasis—frequently due to cystic fibrosis.
3. Lung metastases.

Less common

4. Other pleuropulmonary causes—e.g. pleural fibroma (rare, but has the highest incidence of accompanying HOA), mesothelioma, COPD, pulmonary fibrosis, sarcoidosis, chronic infection (e.g. abscess, empyema, TB), pulmonary AVM.
5. GI disorders—irritable bowel disease, coeliac disease, Whipple’s disease, polyposis, malignancy.
6. Cyanotic congenital heart disease—produces clubbing but only rarely a periosteal reaction.
7. Cirrhosis and hepatobiliary malignancies.

Question 3

Pleuropulmonary causes of HPOA

Answer 3

-pleural fibroma (rare, but has the highest incidence of accompanying HOA),
-mesothelioma,
-COPD,
-pulmonary fibrosis,
-sarcoidosis,
-chronic infection (e.g. abscess, empyema, TB), pulmonary AVM.

Question 4

Types of periosteal reaction :
Two types

Answer 4

Continuous and interrupted

Question 5

Continuous perispteal reaction further divided into ?

Answer 5

Intact cortex and cortex destroyed

Question 6

Types of destroyed cortex continuous periosteal reaction 3

Answer 6

Shell — expanded cortex
Trabeculated shell
Lobulated shell

Question 7

Types of intact cortex continuous periosteal reaction
6

Answer 7

Solid smooth
Solid spiculated
Single lamina
Lamellated
Parallel spiculated— hair on end appearance
Divergent spiculated —- sun burst

Question 8

Interrrupted periosteal reaction types : 4

Answer 8

Buttress
Codman triangle single laminated
Codman multilamellated
Spiculated

Question 9

Bilaterally symmetrical periosteal reactions 4 conditions.

Answer 9

Hypertrophic osteoarthropathy (HOA)

2. Vascular insufficiency—most common in lower limbs due to venous stasis/varicose veins. Often associated with phleboliths.
3. Thyroid acropachy—predominantly radial sided in the thumbs and index fingers.
4. Pachydermoperiostosis
5. Fluorosis—calcification/ossification of tendon and ligament insertions.

Question 10

Most common causes of excessive callus formation : 2

Answer 10

Hypertrophic non union of fracture
Neuropathic arthropathy

Question 11

Children common cause of excess callus formation

Answer 11

Non accidental injury

Question 12

Common causes of osteonecrosis

Answer 12

Steroid
Alcohol
Idiopathic
Fractures
Chemotherapy