4/11/2024 0 Comments Normal pediatric hip xray![]() It is important to note that the fusion of these ossification centers may not take place in this same order in which they appear. ![]() The ossification centers can look very irregular and fragmented as they are developing, particularly the olecranon and trochlea. The mnemonic “CRITOE” ( Capitellum, Radial head, Internal (medial) epicondyle, Trochlea, Olecranon and External (lateral) epicondyle) can help diagnose certain fractures, particularly those where an ossification center ‘appears’ out of the expected order. In order to diagnose pediatric elbow fractures, it is essential to know the order in which the ossification centers about the elbow first appear. Type IV and V injuries tend to cause premature fusion across the growth plate (“physeal bar”) that can result in limb length discrepancy and angulation. Type I-III fractures tend to do well with conservative or surgical treatment, though prognosis is worse in the lower extremities. Salter-Harris V fractures are rare crush injuries to the physis and are often occult on radiographs. Salter-Harris IV fractures involve the physis, epiphysis and metaphysis and have more complications due to the intraarticular extension. 4,5 Salter-Harris III fractures involve the physis and epiphysis. Salter-Harris II fractures involve the physis and part of the metaphysis and are the most common type of physeal injury. A Salter-Harris I fracture passes all the way through the physis without involving the metaphysis or epiphysis and is often initially occult on radiographs. 3 Reviewing the Salter-Harris classification scheme, which is utilized to describe and classify fractures involving the physis, is useful. In general, pediatric joint capsules and ligaments tend to be stronger than the physis, making physeal injuries incredibly common and the mechanical equivalent to ligamentous injuries in adults. Salter-Harris classification of pediatric fractures In this article, we review common pediatric musculoskeletal radiology abnormalities the radiologist may be tasked with assessing, using an anatomic approach. ![]() Magnetic resonance imaging (MRI) often provides complementary information for many different pathologies, but may require sedation, particularly in patients 6 months to 7 years of age. Computed tomography (CT) is best used for detailed fracture analysis to help guide management. ![]() 1,2 Many pediatric fractures, particularly toddlers’ fractures and buckle fractures, are only seen on one view, rendering orthogonal projections essential. Radiographs are the mainstay of pediatric musculoskeletal imaging, making up the majority of imaging exams due to their low cost and minimal risk with regard to radiation exposure. This article is accredited for one SA-CME credit. ![]()
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