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Care should be taken to check for cortication with fragments at the distal pole of the scaphoid, as there is a normal variant of an un-united secondary ossification centre at this site as seen to the right.

DISTAL POLE FRACTURE OF SCAPHOID

This image shows an un-united ulna styloid

The avulsion here is at the base of the middle phalanx and is so small it could be easily missed.

DISLOCATION

# TRAPEZIUM WITH 1ST METACARPAL DISLOCATION

this is more likely to be a remnant of a bifid terminal phalanx that occurs in early growth.

NUTRIENT FORAMINA

# HUMERAL EPIPHYSIS HERE IT IS SLIPPED

NORMAL HERE EPIPHYSIS HAS NOT SLIPPED

This image to the left shows an odd depression in the olecranon giving the appearance that the olecranon epiphysis has been avulsed from it. This is purely developmental and will fill in with age. Return to top.

Forward to the eg. The two images below show the appearance of a bipartite scaphoid. This will almost certainly fuse and go unnoticed later in life, but could remain bipartite. The difficulty with these images is that the appearance does resemble a fracture. However, fractures of the scaphoid in this age group are quite unusual and in this case there was no pain in the carpus. It is not usual to see a fracture of the scaphoid until the the child is around the age of 12.

Normal Variants Of The Hand.


The image to the right shows what looks like an oblique fracture of the proximal half of the third metacarpal. This is in fact a skin fold artefact caused by air trapped in a fold of skin between the thenar eminence and the palm. Look closely and it can be seen that the "fracture" line extends beyond the bone and towards the head of the second metacarpal. Take note also that there is no break in the cortex and no trabecula disturbance.

The images below show the unusual appearance of secondary ossification centres at the base of the second metacarpal and the head of the first metacarpal, the latter being more subtle as it is well fused but more obvious on the image to the right. Note also the subtle fracture of the base of the fifth metacarpal in the image to the left.

Return to top. subtle fracture of the base of the fifth metacarpal in the image to the left.

Pellegrini-Steida MEDIAL COLLATERAL LIGAMENT CALCIFICATION

HEMANGIOMA

RADIAL#

Bucket-handle fractures are caused by a subacute metaphyseal fracture that forms an arc along the proximal margin of the metaphysis. New bone formation leads to a thickened appearance and simulates a handle (arrow shown). Bucket-handle fractures are caused by excessive torsional forces

and are a red flag for potential child abuse. Patients are typically asymptomatic, and treatment is conservative.

Angled buckle fractures in the proximal and distal radius. (A) Note the angled buckle fracture in the proximal radius (arrows). (B) Normal side for comparison; the cortex is smooth. (C) A similar angled buckle fracture (arrows) in the distal radius. (D) Normal side for comparison; the cortex is smooth.

Humeral supracondylar buckle fractures. (A) Posterior buckle fracture. Note the buckled posterior cortex (arrows) secondary to a hyperextensioninduced injury. This fracture represents the low end of the spectrum of supercondylar fractures. Also note that the anterior humeral line intersects the capitellum (dot) through its mid-interior portion. (B) Normal side for comparison. Note that there is no buckle fracture and that the anterior humeral line intersects the capitellum (dot) more posteriorly. (C) Medial buckle fracture. Note the angulated cortex (arrows) resulting from a combination of hyperextension and varus forces. (D) Normal side for comparison. Note how smooth the cortex appears.

Buckle fracture of the anterior tibia. (A) Note the buckle fracture (Fx) and increased concavity (arrows) of the notch for the unossified tibial tubercle. (B) Normal side for comparison. Note how smooth the cortex appears. This fracture is often associated with a subtle, transverse hairline fracture through the upper tibia (see Figure 9).

Classic toddler's fracture. (A) Note the subtle spiral fracture through the distal tibia (arrows). (B) Later, with healing, the fracture is visible more clearly as sclerosis (arrows) occurs along the fracture line.

The white arrows point to the oblique distal tibia fracture. The black arrows with the white outline point to vascular grooves (not a fracture). Re-examine the original radiographs to see if you can see the fracture on the original views.

# RADIAL HEAD

The A.P. view shows a small intra-articular bony fragment lying laterally in the joint space.

This is a slight oblique view and shows the irregularity quite well. This is a small flake fracture from the lateral femoral condyle which could easily be missed if it were not for the lipohaemarthrosis.

This image shows the appearance of "patella teeth", this can be caused by degenerative disease or spurring of the tendon interdigitations

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