As the elbow develops in children, numerous secondary ossification centers appear before and around puberty. It is easy to mistakenly interpret these as fractures. In addition, it is also possible for the epiphyses and apophyses to be “pulled off” or disrupted. Therefore, when interpreting a child’s radiograph of the elbow, the physician must know the child’s age (Fig. 7.75). Fusion occurs at around the time of puberty. An understanding of the normal epiphyses and apophyses and their normal relationship to the bones will secure a correct diagnosis. The approximate ages of appearance of the secondary ossification centers around the elbow joint are: capitulum—1 year, head (of radius)—5 years, medial epicondyle—5 years, trochlea—11 years, olecranon—12 years, and lateral epicondyle—13 years.