Fig. 4.

Appendicular skeleton. At 22 (A) and 33 (B) months of age the lower extremities, and at 7 (C) and 33 (D) months of age the left upper extremity, show sclerosis greatest at the proximal and distal ends of the bones and metaphyseal expansion from tubulation failure greatest in the distal femurs. (E) There are transverse metaphyseal bands of osteosclerosis, as seen in some forms of OPT (arrows). A healing fracture featuring focal bone expansion and periosteal new bone formation is present in the distal left femur at the junction of the sclerotic and nonsclerotic bone (arrows) (A). There is a slight irregularity of the physeal plates and adjacent provisional zones of calcification (C, D, E). Sclerosis in the upper extremities has increased at the ends of the bones between 7 (C) and 33 (D) months of age. In the leg bones and distal right femur, the junction between the sclerotic and nonsclerotic bone is sharp, but not well defined in the proximal femurs or distal left femur. The junction between the sclerotic and nonsclerotic bone can have a transverse or oblique shape.