Multicentric ossification

Last revised by Dr Daniel J Bell on 12 Jan 2019

Multicentric ossification refers to normal, or variant of normal, ossification at more than one site within a single epiphysis or apophysis. It is important to be aware of common sites where multicentric ossification may occur, to avoid confusion with fracture, apophysitis and other entities.

  • tibial tuberosity: may be confused for Osgood-Schlatter disease or avulsion fracture
  • calcaneal tuberosity: may be confused for fracture or Sever disease 
  • humeral trochlea: may be confused for fracture/avulsion
  • pisiform: on lateral wrist radiograph may be confused for partially calcified soft-tissue mass, fracture or foreign body
  • navicular: may be confused for fracture
  • base of 5th metatarsal: may be confused for fracture or apophysitis

Comparison with the contralateral side can be very useful as ossification patterns are often, but not always, symmetric. 

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