Elbow ossification
Updates to Article Attributes
Elbow ossification occurs at the six elbow ossification centers in a reproducible order. Being familiar with the order of ossification of the elbow is important in not mistaking an epicodylar fracture for a normal ossification center.
Appearance
Order
The order of appearances of the elbow ossification centres is highly reliable and in most individuals, is consistent: capitellum, radial head, internal epicondyle, trochlea, olecranon and external epicondyle.
The order of "I" and "T" are most important to remember -; the trochlea ossification center should not appear before the internal (medial) epicondyle ossification centre. If you can see a trochlea but no internal epicondyle, then you need to look very hard for the avulsed ossification center.
Age
Two counting methods are taught to help remember the ages at which the ossification centers appear: 1 - 3 - 5 - 7 - 9 -11 (simple) and 1 - 5 - 7 - 10 - 10 - 11 (more accurate).
- capitellum - 1 year
- radial head - 3 years
- medial epicondyle - 5 years
- trochlea - 7 years
- olecranon - 9 years
- lateral epicondyle - 11 years
Therefore, if the trochlear center is present, but there is no medial epicondyle then you are most likely looking at a medial epicondylar fracture where the ossification centre has been avulsed and displaced. ThisThis is extrememlyextremely important since these injuries should be seen by an orthopaedic surgeon and internally fixed.
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-<p><strong>Elbow ossification</strong> occurs at the six <a href="/articles/elbow-ossification-centers">elbow ossification centers</a> in a reproducible order. Being familiar with the order of ossification of the <a href="/articles/elbow">elbow</a> is important in not mistaking an <a href="/articles/epicodylar-fracture">epicodylar fracture</a> for a normal ossification center. </p><h4>Appearance</h4><h5>Order</h5><p>The order of appearances of the elbow ossification centres is highly reliable and in most individuals, is consistent: <a href="/articles/missing">capitellum</a>, <a href="/articles/radial-head">radial head</a>, <a href="/articles/internal-epicondyle">internal epicondyle</a>, <a href="/articles/trochlea">trochlea</a>, <a href="/articles/olecranon">olecranon</a> and <a href="/articles/external-epicondyle">external epicondyle</a>.</p><p>The order of "I" and "T" are most important to remember - the trochlea ossification center should not appear before the internal (medial) epicondyle ossification centre. If you can see a trochlea but no internal epicondyle, then you need to look very hard for the avulsed ossification center. </p><h5>Age</h5><p>Two counting methods are taught to help remember the ages at which the ossification centers appear: 1 - 3 - 5 - 7 - 9 -11 (simple) and 1 - 5 - 7 - 10 - 10 - 11 (more accurate).</p><ul>- +<p><strong>Elbow ossification</strong> occurs at the six <a href="/articles/elbow-ossification-centers">elbow ossification centers</a> in a reproducible order. Being familiar with the order of ossification of the <a href="/articles/elbow">elbow</a> is important in not mistaking an <a href="/articles/epicodylar-fracture">epicodylar fracture</a> for a normal ossification center. </p><h4>Appearance</h4><h5>Order</h5><p>The order of appearances of the elbow ossification centres is highly reliable and in most individuals, is consistent: <a href="/articles/missing">capitellum</a>, <a href="/articles/radial-head">radial head</a>, <a href="/articles/internal-epicondyle">internal epicondyle</a>, <a href="/articles/trochlea">trochlea</a>, <a href="/articles/olecranon">olecranon</a> and <a href="/articles/external-epicondyle">external epicondyle</a>.</p><p>The order of "I" and "T" are most important to remember; the trochlea ossification center should not appear before the internal (medial) epicondyle ossification centre. If you can see a trochlea but no internal epicondyle, then you need to look very hard for the avulsed ossification center. </p><h5>Age</h5><p>Two counting methods are taught to help remember the ages at which the ossification centers appear: 1 - 3 - 5 - 7 - 9 -11 (simple) and 1 - 5 - 7 - 10 - 10 - 11 (more accurate).</p><ul>
-<a title="Radial head" href="/articles/radial-head">radial head</a> - 3 years</li>- +<a href="/articles/radial-head">radial head</a> - 3 years</li>
-</ul><p>Therefore, if the trochlear center is present, but there is no medial epicondyle then you are most likely looking at a <a href="/articles/medial-epicondylar-fracture">medial epicondylar fracture</a> where the ossification centre has been avulsed and displaced. This is extrememly important since these injuries should be seen by an orthopaedic surgeon and internally fixed.</p><p>{{youtube:http://youtu.be/_PBhCQB4tMQ}}</p><p> </p>- +</ul><p>Therefore, if the trochlear center is present, but there is no medial epicondyle then you are most likely looking at a <a href="/articles/medial-epicondylar-fracture">medial epicondylar fracture</a> where the ossification centre has been avulsed and displaced. This is extremely important since these injuries should be seen by an orthopaedic surgeon and internally fixed.</p><p>{{youtube:http://youtu.be/_PBhCQB4tMQ}}</p><p> </p>
References changed:
- 1. Iyer RS, Thapa MM, Khanna PC et-al. Pediatric bone imaging: imaging elbow trauma in children-a review of acute and chronic injuries. AJR Am J Roentgenol. 2012;198 (5): 1053-68. <a href="http://dx.doi.org/10.2214/AJR.10.7314">doi:10.2214/AJR.10.7314</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/22528894">Pubmed citation</a><span class="auto"></span>
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