Elbow X-ray (peds)

Elbow Ossification by Age (CRITOE)

Ossification Center	Age of Appearance (add 1yr for boys)	Age at Fusion
Capitellum	1yr	12-14 yrs
Radial head	3yr	14-16 yrs
Internal epicondyle	5yr	16-18 yrs
Trochlea	7yr	12-14 yrs
Olecranon	9yr	15-17 yrs
External epicondyle	11yr	12-14 yrs

Reading Film

• Anterior humeral line should intersect with middle third of capitellum (see pediatric elbow alignment)
  • If not, consider supracondylar fracture or lateral condyle fracture
• Line drawn along axis of radial head and neck should pass through middle of capitellum
  • If not, consider fracture of lateral condyle, radial neck, Monteggia, or elbow dislocation
• Fat Pads
  • Anterior may be normal or if large may be abnormal ("sail sign")
  • Posterior is always abnormal

See Also

• Elbow Diagnoses
• Elbow Fractures (Peds)