Question

A patient has a history of road traffic accident 2 years back, and at the same site has developed pain and swelling. X-ray shows the following features. What will be the diagnosis?

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

Hint:

Old trauma site, slow pain/swelling, onion-skin sclerotic periosteal new bone - a chronic infection.

Answer 1

The Correct Option is C

Step 1: The history of trauma 2 years ago at the same site, with later pain and swelling, points to a long-standing low-grade bone infection rather than a fresh tumour. This is chronic osteomyelitis.
Step 2: The X-ray shows periosteal proliferation surrounded by successive layers of condensed cortical bone, giving an onion-skin appearance with sclerosis. This is the picture of Garre sclerosing (chronic non-suppurative) osteomyelitis, a form of chronic osteomyelitis.
Step 3: In this condition mild inflammation and low-grade infection cause subperiosteal new bone deposition. It is frequently asymptomatic or causes only mild pain and swelling, matching the indolent 2-year course.
Step 4: Distractors: Ewing's sarcoma also gives onion-skin periosteal reaction but occurs in younger patients without a remote trauma history and is aggressive. Osteogenic sarcoma shows sunray spiculation and Codman triangle. Multiple myeloma gives punched-out lytic lesions in older adults. The benign sclerotic onion-skin with a trauma history fits chronic osteomyelitis best.