The Ossification centres of the paediatric elbow Xray can cause confusion. Is that normal or is there a fracture? is a common question in this age group. If you remember CRITOE you'll be better prepared! CRITOE refers to the order these ossification centres appear on the Xray. The year of ossification can vary slightly but they always appear in the same order: Capitellum - 1yr (age visible on the Xray) Radial head - 3yrs Internal epicondyl - 5 yrs Trochlear - 7yrs Olecranon - 9yrs External epichondyl - 11 yrs Case courtesy of Leonardo Lustosa, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/80555">rID: 80555</a> Why is this important? Knowing the order will allow you to see if there is an ossification centre missing, i.e it may have avulsed and may be hidden in the Xray. If for example you can see the ossification centre of the trochlear or the olecranon but cannot see the internal epicondyl be very suspicious of an avulsion of the internal epicondyl. The video below from Radiopaedia explains this in greater depth. Martin Dore Nov 2020
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The Rockwood Grading for AcromioClavicular Joint injuries is from 1 to 6.(1) In Grade 1 to 3 there is a varying degree of injury to the AcromioClavicular Ligaments (AC) and the CoracoClavicular ligaments (CC). Radiographically this translates into a 25-100% CoracoClavicular (CC) distance. For Grade 4-6 the disruption of the AC and CC ligaments and the Deltopectoral Fascia is more severe. For Grade 5 the CC distance is >100% of normal. (2) Grade 1-3 Injuries can be managed conservatively with a Broad Arm Sling, Analgesia, an Advice Sheet and discharge. The orthopaedic referral chart (Accessed Oct 2020) states between 0830-2200 Grade 4-6 Injuries should be discussed with the Orthopaedic team on call and between 2200-0830 discussion is not indicated but a fracture clinic triage should be completed. Please ensure Senior ED discussion for all Grade 4-6 Injuries and especially if there is any suspicion of Major Mechanism, Open Injury or Neurovascular Compromise. Ref1. https://faculty.washington.edu/jeff8rob/trauma-radiology-reference-resource/9-upper-extremity/rockwood-classification-of-acromioclavicular-joint-separation/ Ref2. https://www.researchgate.net/figure/Rockwood-classification-of-acromioclavicular-injuries_tbl1_272096166 Steve Fordham Oct 2020 |
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