Primary Hypertrophic osteoarthropathy Tibial periosteal new bone formation Tibial periosteal new bone formation Primary Hypertrophic osteoarthropathy Tibial periosteal new bone formation Tibial periosteal new bone formation Tibial periosteal new bone formation Primary Hypertrophic osteoarthropathy periosteal reactive Primary Hypertrophic osteoarthropathy periosteal reaction Tibial periosteal new bone formation