Child Elbow Ossification Centers:Elbow Diagram,Radiographic Findings

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ELBOW OSSIFICATION CENTERS IN A CHILD

Radiology Cases in Pediatric Emergency Medicine Volume 1, Case 11

Alson S. Inaba, MD

Continue....

Review elbow diagram.

Knowing the C-R-I-T-O-E mnemonic is helpful in determining whether a small piece of bone about the elbow joint represents an avulsion fragment or an ossification center. The ossification centers always appear in the order specified in the mnemonic C-R-I-T-O-E.
Example:

If you see only three accessory bony fragments about an elbow joint, these bony pieces should be in the areas of the capitellum, radial head and the internal (medial) epicondyle. If one of the three bony fragments is in the area where you would expect to see the external epicondyle, then that piece actually represents an avulsion fracture of the distal, lateral humerus, rather than a normal external epicondyle.
Whenever evaluating an injured extremity, the most important aspect of the examination is to assess the neurovascular integrity of the affected extremity.
Always remember to palpate the entire extremity (including the clavicles) in all children who present after falling on the out-stretched arm.
Always remember to document whether or not the patient who has fallen on the outstretched hand has any tenderness over the anatomic "snuffbox"(scaphoid bone). Any patient with tenderness over the scaphoid (navicular) bone must be treated (splinted with orthopedic referral) as an occult scaphoid fracture until proven otherwise (even if the initial scaphoid views do not reveal any evidence of a fracture). Refer to Case 14 (A Hand Contusion) for more details.

Radiographic Findings:

No evidence of elbow effusion. Normal anterior humeral line and a normal radiocapitellar line. (Refer to Case 12, Radiographic Examination of the Elbow, to learn how to assess elbow effusions and how to measure the anterior humeral and radiocapitellar lines). All six ossification centers are present in their expected anatomic positions.

Overall radiographic interpretation: Normal right elbow with normal ossification centers.

Copyrighted:Radiology Cases in Pediatric Emergency Medicine Volume 1, Case 11 Loren Yamamoto, MD, MPH Associate Professor of Pediatrics University of Hawaii John A. Burns School of Medicine loreny@hawaii.edu

Last created on 12-05-2001
Last modified on 01-07-2006

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