Reading Pediatric Elbow X-rays
Ossification order and the lines that reveal injury.
Aug 31, 2026 · 3 refs
At a glance
Pediatric elbow films fail when you treat them like adult films. CRITOE (capitellum, radial head, internal epicondyle, trochlea, olecranon, external epicondyle) tells you what should be there at that age. Anterior humeral line and radiocapitellar line still apply.
Technique pointers
Every pediatric elbow
- CRITOE order — a “missing” ossification center that should have appeared is a fracture or displaced fragment until proven otherwise
- Anterior humeral line through the middle third of the capitellum
- Radiocapitellar line on AP and lateral
- Fat pads; comparison views of the other elbow when unsure
Decision-making
Supracondylar displacement and a medial epicondyle in the joint change the night. If the ossification sequence and the lines disagree with a “nursemaid” story, get a better lateral and a senior look before you send them home.
High-yield / exam
- CRITOE before you call it normal
- Anterior humeral line and radiocapitellar line
- Comparison views are allowed
- Occult fracture pathway with a posterior fat pad
Questions
Ortho Skills (Real Life) and Boards items for this topic are coming.
Your pearl
One line you’d tell a junior at 2am.
References
- 01
Pediatric elbow fractures — radiographic interpretation
2012 · Journal of Pediatric Orthopaedics · review
Ossification sequence is the pediatric-specific part of the system.
- 02
Pediatric supracondylar humerus fractures — imaging and classification
2014 · Journal of the American Academy of Orthopaedic Surgeons · review
Gartland thinking starts with a true lateral and the anterior humeral line.
- 03
AAOS themes on pediatric elbow injury evaluation
2011 · American Academy of Orthopaedic Surgeons (guidelines / AUC) · guideline
Comparison views and a repeatable line check prevent missed operative injuries.
From the Journal
Films and cases live in the long-form. This Topic is the system.
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