Pediatric elbow radiograph (an approach)

Last revised by Arlene Campos on 24 Jun 2024

Pediatric elbow radiographs are commonly encountered in the emergency department and, when approached in a systematic fashion, are not as difficult to interpret as most people think!

Check that the ossification centers are present and in the correct position. They appear in a predictable order and can be remembered by the mnemonic CRITOE (age of appearance are approximate):

Check the anterior humeral line:

  • drawn down the anterior surface of the humerus

  • should intersect the middle 1/3 of the capitellum

  • if it does not, think supracondylar fracture

(under the age of 4, the line will intersect the anterior 1/3)

Check the radiocapitellar line:

Check for raised fat pads:

Check around every bone on the film:

  • 10-20% of all pediatric elbow injuries

  • peak age: 6-10 years

  • mechanism: usually varus force applied to an extended elbow

  • unstable intra-articular fracture

  • prone to displacement due to the pull of forearm extensors

  • more: lateral condyle fracture

  • 5% of all pediatric elbow fractures

  • peak age: 8-11 years

  • mechanism: FOOSH with extended elbow and supinated forearm

  • most fractures involve the physis

  • more: radial neck fracture

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