W1-2 Pediatrics

Ossification sequence of carpal bones

1. cap

2. ham

3. tri

4. lun

5. scaph

6. trapezium

7. trapezoid

8. pisi

capitate age of ossification

1-3 months

hamate age of ossification

2-4 months

triquetrum age of ossification

2-3 years

lunate age of ossification

2-4 years

scaphoid/ trapezium/ trapezoid age of ossification

4-6 years

pisiform age of ossification

8-12 years

distal radius age of ossification

1 year

distal ulna

5-6 years

Elbow age of ossification sequence

1. capitulum

2. radial head

3. medial epicondyle

4. trochlea

5. olecranon

6. lateral epicondyle

capitulum age of ossification

1 year

radial head age of ossification

3 yr

medial epicondyle age of ossification

5 yr

trochlea age of ossification

7 yr

olecranon age of ossification

9 yr

lateral epicondyle age of ossification

11 yr

presence of trochlea but absence of medial epicondyle indication

epicondylar fx

1st skeletal development bone

foot

tarsal bone ossification from 9 weeks - 9 months from birth

• calcaneus

• talus

• cuboid

• metatarsals

• phalanges

tarsal primary ossification centers after birth

• 1st Year - Lateral Cuneiform

• 3rd Year - Medial Cuneiform

• 4th Year - Intermediate Cuneiform and Navicular

tibia age of ossification

• tibial shaft - 7 weeks in utero

• distal tibia - 4-12 months

fibula age of ossification

• fibula shaft - 8 weeks in utero

• distal fibula - 6-12 months

Distal femur age of ossification

• femoral shaft: 8 weeks in utero

• distal femur: 3-6 months

patella age of ossification

3-5 yrs

Proximal Tibia

• tibial shaft: 7 weeks in utero

• tibial plateau: 9 months in utero

• tibial tuberosity 10-12 yrs

proximal fibula age of ossification

• fibular shaft: 8 weeks in utero

• fibular head: 2-4 yrs

Proximal Femur age of ossification

• shaft: 7 weeks in utero

• femoral head: 4-6 months

• GT: 2-4 yrs

• LT: puberty

Pelvis age of ossification

• ilium: 8 weeks in utero

• ischium: 4-6 moths in utero

• pubis: 4-6 months in utero

• acetabulum: puberty

femoral ossification centers fusion

14-18 yrs

ilium, ischium and pubis fusion

7-9 yrs

acetabulum fusion

20-25 yrs

Primary ossification centers of the spine

cervical and upper thoracic spine at 9 weeks in utero → upper cervical (C1/C2) → lumbar and distal thoracic vertebrae → neural arches of the lumbar spine at 14 weeks in utero

secondary ossification centers of the C3-L5

appear at puberty and fuse by 25-30 yrs

C1 age of ossification

• posterior neural arch: 3 yr

• anterior arch: 7 yr

C2 age of ossification

• body: visible at 1 yr and fuse at 4 yr

• tip of dens: 3-6 yrs

is gonadal shielding required for pediatrics

no

Down syndrome (DS) is also knows as

Trisomy 21

Common Xrays for DS Pediatrics

c-spine imaging to visualize the space between C1 and C2

Key points of Bone Age Studies

• the left hand will always be imaged regardless of dominance

• the epiphyseal centers of the hand must be seen

New Born to 6 months - Typical Bone Age Study

AP Left Knee (knees are done when epiphyseal centers are not seen on a hand)

6.5 months to 1 year - Typical Bone Age Study

1. AP Left Knee

2. Lateral Left Knee (if radiologist requests)

1 to 2 years - Typical Bone Age Study

1. PA left hand/wrist (only if epiphyseal centers are present for the MC's/phalanges)

2. AP left knee

3. Lateral left knee

2 and above - Typical Bone Age Study

PA left hand/wrist