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Background <p>The pediatric elbow represents one of the most challenging joints in musculoskeletal imaging. Age-dependent ossification centers, projectional superimposition, and indirect radiographic signs frequently lead to diagnostic pitfalls with relevant therapeutic consequences.</p> Objective <p>To summarize typical pitfalls in pediatric elbow imaging and to provide practical diagnostic strategies.</p> Methods <p>This narrative review is based on a&#xa0;selective literature search conducted in the PubMed and Embase databases. Primarily English- and German-language publications from the past 15&#xa0;years were considered, supplemented by relevant standard textbooks and clinical guidelines. Literature selection focused on clinically relevant aspects of pediatric elbow imaging, particularly diagnostic pitfalls, radiographic reference lines, and complementary imaging modalities. Given the educational nature of this article, no systematic literature selection in accordance with a&#xa0;Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol was performed.</p> Results <p>Conventional radiography in two orthogonal planes remains the cornerstone of pediatric diagnostics. Knowledge of the physiological sequence of ossification (CRITOE) is essential to differentiate normal variants and fractures. Reference lines, such as the anterior humeral line, Baumann angle, and radiocapitellar line aid in fracture identification. The elevated fat pad sign is a&#xa0;sensitive but nonspecific indicator of intra-articular injury. Ultrasound, CT, and MRI are used to supplement diagnostics in selected cases, particularly in occult fractures or complex injury patterns. Typical pitfalls include radial head dislocations, misinterpretation of ossification centers, and projection-related assessment errors.</p> Conclusion <p>Accurate diagnosis requires systematic two-plane radiography, awareness of age-specific fracture patterns, and interdisciplinary collaboration. Structured reporting algorithms may significantly reduce avoidable misdiagnoses.</p>

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Besonderheiten des kindlichen Ellenbogengelenks in der Bildgebung – welche Pitfalls gibt es?

  • 期刊论文

  • 发表日期：

    2026年6月24日

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  • Julian H. W. Jürgens,
  • Kristofer Wintges

摘要

Background

The pediatric elbow represents one of the most challenging joints in musculoskeletal imaging. Age-dependent ossification centers, projectional superimposition, and indirect radiographic signs frequently lead to diagnostic pitfalls with relevant therapeutic consequences.

Objective

To summarize typical pitfalls in pediatric elbow imaging and to provide practical diagnostic strategies.

Methods

This narrative review is based on a selective literature search conducted in the PubMed and Embase databases. Primarily English- and German-language publications from the past 15 years were considered, supplemented by relevant standard textbooks and clinical guidelines. Literature selection focused on clinically relevant aspects of pediatric elbow imaging, particularly diagnostic pitfalls, radiographic reference lines, and complementary imaging modalities. Given the educational nature of this article, no systematic literature selection in accordance with a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol was performed.

Results

Conventional radiography in two orthogonal planes remains the cornerstone of pediatric diagnostics. Knowledge of the physiological sequence of ossification (CRITOE) is essential to differentiate normal variants and fractures. Reference lines, such as the anterior humeral line, Baumann angle, and radiocapitellar line aid in fracture identification. The elevated fat pad sign is a sensitive but nonspecific indicator of intra-articular injury. Ultrasound, CT, and MRI are used to supplement diagnostics in selected cases, particularly in occult fractures or complex injury patterns. Typical pitfalls include radial head dislocations, misinterpretation of ossification centers, and projection-related assessment errors.

Conclusion

Accurate diagnosis requires systematic two-plane radiography, awareness of age-specific fracture patterns, and interdisciplinary collaboration. Structured reporting algorithms may significantly reduce avoidable misdiagnoses.