Presentation
Fall injury
Patient Data
The anteroposterior view shows an oval calcific image at the medial epicondyle, which can be ascribed to an avulsion fracture as the ossification center of the radial head is not yet appreciable. The contralateral projection, in which both the ossification nucleus of the radial head and the medial epicondyle are missing, confirms the diagnosis.
The lateral projection shows the rise of the anterior and posterior fat pads, related to joint effusion.
Case Discussion
The knowledge of the growth sequence of the ossification nuclei (CRITOE) is fundamental in the diagnosis of elbow fractures in children. Every ossification nucleus that appears in the wrong order is suspicious of a fracture.
In the present case, we observe the ossification nucleus of the capitellum, but the radial head has not yet appeared, so the display of an eventual medial epicondyle center must be regarded with suspicion.
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