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Gender-specific pattern differences of the ossification centers in the pediatric elbow

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Abstract

Background

Only a limited number of studies have investigated the age ranges in which the secondary centers of the elbow appear and ossify. Knowledge of sequence, gender differences and age ranges can aid in accurate assessment of radiographs, especially in cases of injury.

Objective

To determine the sequence and general age ranges in which each ossification center both appears and fuses, and also to identify differences between genders.

Materials and methods

This study included 412 sets of radiographs of children’s elbows that were analyzed prospectively by a single experienced pediatric radiologist. The presence as well as state of fusion of each ossification center was noted. The ages of the children ranged from 2 months to 17 years.

Results

In girls, the radial head and medial epicondyle appeared at the same age. In boys, there was a trend towards the radial head appearing earlier than the medial epicondyle. There was no statistically significant difference between the age at which the trochlea and olecranon appeared. Our results demonstrate a statistically significant difference between genders in both appearance and fusion. All centers both appeared and fused earlier in girls, with the exception of the appearance of the capitellum. The sequence of appearance and fusion was similar between genders.

Conclusion

Ossification centers at the elbow both appear and fuse earlier in females but the normal range in age for the times of appearance and fusion of these centers is quite wide for both sexes.

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Correspondence to Bijal Patel.

Appendix

Appendix

Ossification center appearance

Graph 1
figure 2

Percentage of children with the capitellum present at various ages. There was no significant difference between genders for the percentage of subjects at a given age (P=0.81). However, the number of children in this category was inadequate

Graph 2
figure 3

Percentage of children with the radial head present at various ages. In girls the radial head appeared earlier than in boys. At any given age a greater percentage of girls demonstrated a radial head (% P<0.05, slope P=0.20)

Graph 3
figure 4

Percentage of children with the medial epicondyle present at various ages. In girls the medial epicondyle appeared earlier than in boys. At any given age a greater percentage of girls demonstrated a medial epicondyle (% P<0.05, slope P=0.67)

Graph 4
figure 5

Percentage of children with the trochlea present at various ages. In girls the trochlea appeared earlier than in boys. At any given age a greater percentage of girls demonstrated a trochlea (% P<0.05, slope P=0.88)

Graph 5
figure 6

Percentage of children with the olecranon present at various ages. In girls the olecranon appeared earlier than in boys. At any given age a greater percentage of girls demonstrated an olecranon (% P<0.05, slope P=0.47)

Graph 6
figure 7

Percentage of children with the lateral epicondyle present at various ages. In girls the lateral epicondyle appeared earlier than in boys. At any given age a greater percentage of girls demonstrated a lateral epicondyle (% P<0.05). The rate of change of the percentage of children at any given age was significantly different between genders (slope P<0.05)

Ossification center fusion

Graph 7
figure 8

Percentage of children with a fused capitellum at various ages. In girls the capitellum fused earlier than in boys. At any given age a greater percentage of girls demonstrated fusion (% P<0.05, slope P=0.07)

Graph 8
figure 9

Percentage of children with a fused radial head at various ages. In girls the radial head fused earlier than in boys. At any given age a greater percentage of girls demonstrated fusion (% P<0.05, slope P=0.41)

Graph 9
figure 10

Percentage of children with a fused medial epicondyle at various ages. In girls the medial epicondyle fused earlier than in boys. At any given age a greater percentage of girls demonstrated fusion (% P<0.05, slope P=0.10)

Graph 10
figure 11

Percentage of children with a fused trochlea at various ages. In girls the trochlea fused earlier than in boys. At any given age a greater percentage of girls demonstrated fusion (% P<0.05, slope P=0.75)

Graph 11
figure 12

Percentage of subjects with a fused olecranon at various ages. In girls the olecranon fused earlier than in boys. At any given age a greater percentage of girls demonstrated fusion (% P<0.05, slope P=0.21)

Graph 12
figure 13

Percentage of children with a fused lateral epicondyle at various ages. In girls the lateral epicondyle fused earlier than in boys. At any given age a greater percentage of girls demonstrated fusion (% P<0.05, slope P=0.70)

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Patel, B., Reed, M. & Patel, S. Gender-specific pattern differences of the ossification centers in the pediatric elbow. Pediatr Radiol 39, 226–231 (2009). https://doi.org/10.1007/s00247-008-1078-4

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  • DOI: https://doi.org/10.1007/s00247-008-1078-4

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