Preschooler with a limp

Radiograph of growth arrest lines in the long bones — AP radiograph of the lower extremity shows two dense fine lines in the proximal metaphysis of the femur, and in the proximal and distal metaphyses of the tibia and fibula.

The diagnosis was growth arrest lines.

Teenager who stepped on a pencil in their bare feet

Radiograph of pencil tip in the subcutaneous soft tissues of the foot — Lateral radiograph of the ankle shows a faintly radiopaque pointed object in the heel of the foot as indicated by the arrow.

The diagnosis was a foreign body in the soft tissues of the heel in the form of a pencil tip.

Newborn who experienced shoulder dystocia during delivery and now has pain when the left arm is moved

Radiograph of humerus fracture — AP radiograph of the upper extremity shows a fracture line through the diaphysis of the humerus. The fracture fragments are not in anatomic alignment and apposition.

The diagnosis was fracture of the proximal humerus.

Teenager who hurt their knee playing football

Radiograph of tibial plateau fracture — AP radiograph of the knee (left) shows a linear lucency associated with the medial aspect of the proximal metaphysis. Lateral radiograph (right) shows a linear lucency associated with the posterior aspect of the metaphysis.

The diagnosis was tibial plateau fracture.

School ager with leg pain

Radiograph of stress fracture of proximal tibia — AP (left) and lateral (right) radiographs of the tibia and fibula show a double density in the tibial metaphysis which has periosteal reaction associated with it medially and posteriorly.

The diagnosis was stress fracture of the proximal tibia.

Teenager with leukemia and pancytopenia and knee pain

MRI of avascular necrosis of knee — Sagittal T1 (left) and STIR (right) MRI without contrast of the knee show a large knee joint effusion along with well demarcated serpiginous lesions in the distal femur and proximal tibia that on STIR images demonstrate the double line sign.

The diagnosis was avascular necrosis of the knee.

Infant with hepatosplenomegaly, jaundice, and a maculopapular rash

Radiograph of syphilis of long bones — AP radiograph of the knee at presentation (left) shows faint periostitis of the distal femur and proximal tibia and fibula. There is a metaphyseal lucency present along the proximal portion of the medial aspect of the tibial metaphysis (Wimberger corner sign). Repeat radiograph obtained 2 months later while on therapy (right) shows dense periostitis of the bones with resolution of the lesion previously seen on the proximal medial tibial metaphysis.

The diagnosis was syphilis.

Teenager with right wrist pain after trauma

Radiograph of scaphoid fracture — AP radiograph of the wrist (left) shows a double density over the scaphoid bone. Scaphoid view (right) shows a lucency through the waist of the scaphoid bone with displacement of the fracture fragments.

The diagnosis was scaphoid fracture.

Preschooler with left hip pain

Radiograph of Meyer dysplasia — AP radiograph of the hips shows a normal appearing left hip. There is flattening and sclerosis of the right femoral epiphysis which may have multiple ossification centers and there is also right metaphyseal subcortical cystic change.

The diagnosis was Meyer dysplasia.

Teenager who jammed their finger in a door

Radiograph of Salter Harris Type III phalanx fracture — Lateral radiograph of the hand shows a fracture line through the physis and extending into the epiphysis of the fourth middle phalanx. There is a fracture fragment displaced dorsally.

The diagnosis was Salter Harris Type III fracture of the fourth middle phalanx.

Infant with a maculopapular rash on the buttocks

Radiograph of syphilis — AP radiographs of the bilateral lower extremities show diffuse, thick, symmetric periosteal reaction bilaterally. There is a suggestion of a metaphyseal notch on the proximal medial right tibial metaphysis (Wimberger corner sign).

The diagnosis was syphilis.

Teenager who has pain in his fifth digit after it was hit by a football

Radiograph of fracture dislocation of the fifth phalanx of the hand — AP (left), oblique (middle) and lateral (right) radiographs of the fifth digit show a complete dislocation of the fifth middle phalanx from the fifth proximal phalanx.

The diagnosis was fracture dislocation of the fifth proximal interphalyngeal joint of the hand.

Teenager who is a right handed baseball pitcher who has increasing right elbow pain over the last month

Radiograph of little leaguer elbow — AP radiograph of the right elbow (right) shows avulsion of the medial epicondyle with mild widening of the physis and mild adjacent sclerosis and cortical irregularity which is best appreciated when comparing it to the normal left elbow (left).

The diagnosis was little leaguer elbow of the right arm.

Teenager playing baseball who felt their left hip pop while sliding into base

Radiograph of pelvis and hip apophyseal fracture of the lesser trochanter. — AP radiograph of the left hip shows avulsion of the apophysis of the lesser trochanter.

The diagnosis was a pelvis and hip apophyseal fracture of the lesser trochanter.

Teenager who suffered a crush injury to the foot while riding an all terrain vehicle

Radiograph of Lisfranc fracture dislocation of the foot — AP (left) and lateral (right) radiographs of the foot shows malalignment of all of the metatarsal bones with their respective tarsal bones. There are a large number of radiopaque foreign objects in the plantar aspect of the foot

The diagnosis was Lisfranc fracture dislocation.

Teenager with left hip pain after trauma and a decreasing hemoglobin

CT of pelvis fracture with active bleeding into the pelvis — AP radiograph of the pelvis (above left) shows fractures through the left iliac wing and the left superior and inferior pubic rami. A large hematoma in the muscle medial to the iliac wing fracture is demonstrated on the axial CT with contrast of the pelvis (above right). Axial CT with contrast of the pelvis on initial images (below left) shows a focal round and linear high density object near the left pubic ramus fracture which on the delayed images (below right) has grown much larger in size.

The diagnosis was pelvis fracture with active bleeding into the pelvis.

School ager hit in right hip while playing football with right hip pain

Radiograph of traumatic hip dislocation — AP radiograph of the pelvis shows the right femoral head to be dislocated posteriorly out of the right acetabulum. There is also a fracture of the posterior wall of the right acetabulum.

The diagnosis was traumatic hip dislocation.

Preschooler with left hip pain after fall

Radiograph of pathologic fracture through a unicameral bone cyst — AP (above) and frog-leg (below) radiographs of the hips shows an intramedullary lesion in the left hip metaphysis with multiple locules and without periosteal new bone. A lucent defect is seen along its medial cortical surface on both views.

The diagnosis was pathologic fracture through a unicameral bone cyst.

Teenager who hurt their knee playing basketball

Radiograph and CT of tibial tuberosity avulsion fracture — AP radiograph of the knee (left) shows a double density projecting over the lateral aspect of the proximal tibia. Lateral radiograph of the knee (middle) shows a moderate suprapatellar joint effusion and elevation of the tibial tubercle away from the tibia. Sagittal CT without contrast of the knee (right) shows a fracture line involving the tibial tubercle and extending superiorly into the tibial epiphysis.

The diagnosis was tibial tuberosity avulsion fracture resulting in a Salter Harris Type IV fracture.

Teenager who punched his bed frame as he was falling out of bed

Radiograph of boxer's fracture — AP (left) and oblique (right)radiographs of the hand show an angulated and minimally displaced fracture of the metaphysis of the fifth metacarpal.

The diagnosis was boxer fracture of the fifth metacarpal.

Infant with in-utero exposure to a sexually transmitted disease

Radiograph of Wimberger's sign in syphilis — AP radiograph of the lower extremity shows diffuse periostitis of the tibia and some destructive changes on the medial proximal metaphysis of the tibia (Wimberger’s sign).

The diagnosis was syphilis.

Teenager with a palpable right upper chest wall mass

CXR of a bifid rib — CXR AP at 1 day of life (above) shows the right third rib to bifurcate starting posteriorly into two separate ribs. CXR AP today at 16 years of age (below) clearly shows the two heads of the right third rib.

The diagnosis was right third bifid rib.

Preschooler who fell on to their arm

Radiograph of greenstick fracture — AP (above) and lateral (below) radiographs of the forearm show incomplete nondisplaced fractures through the diaphysis of the radius and the ulna.

The diagnosis was greenstick fracture of the radius and ulna.

Teenager with a distal thigh mass

Radiograph of osteochondroma — AP (left) and lateral (right) radiographs of the knee show a pedunculated cartilage-capped lesion on a bony stalk in the metaphysis of the femur that is growing away from the physis.

The diagnosis was osteochondroma.

Teenager who fell and twisted their foot and now has pain at the base of the fifth metatarsal

Radiograph of 5th proximal metatarsal fracture (Jone's fracture) — AP radiograph of the foot shows a transverse lucency through the base of the fifth metatarsal.

The diagnosis was a fifth metatarsal fracture.