Os Radiale Externum -Plain film

11yr old child with history of trauma. Professor-resident series by Dr MGK Murthy.

How do we read this picture?

An ill defined irregular radio opacity seen dorsal surface of scaphoid  with no significant soft issue abnormality.

is it a fracture?

In this case that is difficult  to answer precisely as the comparative picture for other side does not show this and usually the accessory ossification center for this region called Os Radiale Externum  is bilateral.

 How do we report?

The interpretation for this radiograph should be as fracture until follow up X -ray after 2 weeks is performed

 Is cross sectional imaging helpful?

Unlikely as  both CT and MRI are only likely to suggest the lesion in better demonstration and  growing accessory ossification center at times is difficult to separate from fresh fracture.  Of course MR may demonstrate the soft tissue delineation better

How about nuclear medicine ?

Not likely to play major role for the same reason

What is the best way out for the child?

I  would go by the local tenderness as scaphoid fracture has been diagnosed by tenderness from time immemorial. I would request the clinician to treat the lesion as fracture until 2 weeks repeat X ray and Fracture never stays quiet for 2weeks and any sign of healing and callus is good enough suggestion. In this patient, as there is no displacement, it needs to be treated conservatively in any case