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A new look at the sequential development of elbow-ossification centers in children
J C Cheng1, K Wing-Man, W Y Shen
1Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT.
Insights
This study reexamined elbow ossification patterns in 1,577 Chinese children, finding the sequence consistent between sexes but delayed in boys. Results provide updated reference charts for pediatric elbow development.
Area of Science:
- Pediatric Orthopedics
- Radiology
- Human Osteology
Background:
- Existing data on pediatric elbow ossification patterns are over 30 years old.
- Accurate ossification timing is crucial for diagnosing developmental abnormalities and injuries.
Purpose of the Study:
- To reexamine and update the sequence and pattern of secondary ossification centers around the elbow in Chinese children.
- To establish current percentile charts for elbow ossification in both sexes.
Main Methods:
- Cross-sectional study of 3,154 elbow radiographs from 1,577 Chinese children (newborn to 17 years).
- Radiographs included normal and injured elbows for comparison.
- Percentile charts were constructed for each ossification center by sex.
Main Results:
- The ossification sequence was consistent in both sexes: capitulum, radial head, medial epicondyle, olecranon, trochlea, and lateral epicondyle.
- Girls showed ossification at 1, 5, 5, 9, 9, and 10 years for these centers.
- Boys exhibited a similar sequence but with an average 2-year delay for most centers, except the capitulum.
Conclusions:
- The study provides updated, sex-specific percentile charts for elbow ossification in Chinese children.
- Findings confirm a consistent ossification sequence but highlight sex-based timing differences.
- These updated data are valuable for clinical assessment of pediatric elbow development and injuries.
Abstract:
The pattern and sequence of ossification of the six secondary ossification centers around the elbow in the child were mainly derived from studies done >30 years ago. This series reexamined the sequence and pattern based on a cross-sectional study of the elbow radiographs of 1,577 Chinese children with elbow injuries; age range, from newborn to 17 years. The ratio of girls to boys was 1:2. Each child had a radiograph of the normal and the injured elbow giving a total of 3,154 radiographs. A percentile chart of ossification was constructed for each of the ossification centers in both sexes for easy reference. No differences in the timing and ossification pattern were found between the right and left elbow or between the normal and injured elbow in this study. The sequence of ossification in both boys and girls was found to be the same (i.e., the capitulum first, followed by the radial head, medial epicondyle, olecranon, trochlea, and last, the lateral epicondyle). The ages at which 50% of the girls were found to have positive radiologic ossification for each of these centers were ages 1, 5, 5, 9, 9, and 10 years, respectively. In boys, with the exception of the capitulum, an average delay of 2 years was found in each of the ossification centers, although the sequence remained similar.