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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