Which periosteal reactions are seen with an infection?

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Periosteal reaction patterns reflect how the periosteum responds to bone irritation, such as infection. In osteomyelitis, the inflammatory process can push the periosteum away and stimulate new bone formation in different ways, depending on how quickly and aggressively the infection spreads. A solid reaction forms when new bone lays down smoothly and continuously, often seen with slower or chronic inflammation. Laminated, or onion-skin, layering happens with more rapid or repeated irritation as new layers stack up. Codman triangle appears when the periosteum is rapidly elevated at the edge of the cortex, creating a triangular an aggressive edge of new bone. Because infection can produce any of these patterns, the best choice lists all three possibilities: solid, laminated, or Codman triangle. This pattern isn’t exclusive to infection; Codman triangle can also show up in aggressive conditions, but infection can present with all three forms, making the comprehensive option the most accurate.