Volume 1, Case
11
Elbow Ossification Centers in a Child
Radiology Cases in Pediatric Emergency Medicine
Volume 1, Case 11
Alson S. Inaba, MD
A 7 year old male presents to
the ED with isolated right elbow pain three hours after falling on his out-stretched
right arm while roller blading. The patient did not sustain any other trauma
to his head, neck or trunk. He has not complained of any numbness or tingling
in his right hand post-injury.
Exam: The right upper extremity
from the clavicle to the tip of the fingers is atraumatic in appearance
without any obvious angulation or swelling. The patient exhibits full
range of motion about the shoulder and wrist. There is no tenderness over
the anatomic "snuffbox" region. The elbow has no obvious swelling, and
the elbow circumference (of the affected arm) is equal to the elbow circumference
of the non-affected arm. There is very mild, diffuse tenderness about
the right elbow (without any specific point tenderness). He has no pain
with active elbow flexion, extension, supination, or pronation. Although
you clinically do not suspect any fracture of the right elbow region,
the patient's mother is very anxious and demands an x-ray of her son's
elbow. Radiographs of the right elbow are obtained.
View elbow radiographs.
X-Ray
Click
here for a better picture
Questions:
1) How many ossification centers are present in this
radiograph and what are the names of these
ossification centers?
2) Are the ossification centers in their correct
(expected) anatomic positions?
3) Are there any fractures present in this
radiograph, and if so where?
What is your Diagnosis?
Click
here for the Case 11 Answers
Loren Yamamoto,
MD, MPH Associate Professor of Pediatrics University of Hawaii John A. Burns
School of Medicine loreny@hawaii.edu
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