Interpretation of elbow radiographs can be complicated.
There are a lot of ossification centers in the elbow that can be confusing.
Elbow trauma and injuries are common and ossification centers can look like
bony fragments, and bony fragments can look like ossification centers. Knowing
the time of development of the normal ossification centers can be important.
Although this timing may be variable, you can guess the approximate time of the
appearance of the ossification centers by using the mnemonic CRITOE. CRITOE, 1
3 5 7 9 11, are the ages when the ossification centers appear around the elbow.
The time of appearance of these ossification centers is reliable, although they
can be variable, especially in girls where they can occur earlier than in boys,
sometimes by two years earlier. A rough timing estimate that is easy or simple
will be helpful. This is more helpful in looking for the medial epicondyle for
example, after an elbow dislocation that is avulsed and may be trapped in the
joint, and you could not find it in its normal location because you could not
remember if the ossifications center was even developed. If you find the
trochlea ossification center and you do not find the medial epicondyle
ossification center in its normal location, then look inside the joint,
especially if you know the age of the patient and you know that the internal or
the medial epicondyle should be developed by then. The internal epicondyle
(medial) should be seen because it develops before the trochlear ossification
center. One of the most important things is to know the age of the patient.
Look for the normal position of the ossification center. Finding what appears
to be a fracture or an ossification center in the area of the olecranon or the
lateral epicondyle in a young child (5 years) should not be interpreted as an
ossification center which should be developed later.
