In a 3-year-old child, which epiphyseal centre SHOULD be present around the elbow on a plain X-ray according to the CRITOE sequence?

• A Radial head only
• B Capitellum and radial head
• C Capitellum, radial head, and internal (medial) epicondyle
• D Capitellum only ✓

Explanation

CRITOE sequence gives the approximate age (in years) of appearance of elbow ossification centres: Capitellum (1), Radial head (3), Internal (medial) epicondyle (5), Trochlea (7), Olecranon (9), External (lateral) epicondyle (11). At age 3, only the capitellum (age 1) is definitely expected; the radial head appears at around 3 years so it may just be appearing. Strictly, at age 3 only the capitellum is reliably present. Knowledge of CRITOE prevents misidentifying normal ossification as fracture fragments.

Reference: BD Chaurasia's Human Anatomy, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.