Unusual secondary ossification center for scaphoid tubercle-Plain Film

11 yr old child with history of trauma with pain wrist. Questions between Professor and the resident. Submitted by Dr MGK Murthy.
1.What is this?
Stippled scaphoidal tuberosity region with no associated soft tissue or articulation abnormality

2. is it fracture?
Even though there is history of fall , this not likely to represent fracture

3. Then what is the possibility?
In this age group(11 years) , unusual secondary ossification center for scaphoid tubercle needs consideration

4.When does scaphoid osification center normally appear?
It varies between 4 to 7 years

5. How to confirm?
Follow up after 2 weeks and comparison wwith other noninjured side is usually rewarding, as it is often bilateral

6. when do we confirm that it is secondary ossification center?
After the union of the bone in the normal course ,though sometimes it could remain separate

7. what is the importance of tubercle of scaphoid?
Flexor retinaculum and abductor pollcisbrevis are attached here

8. What are accessory bones of scaphoid?
Refers to replacement of residual secondary ossification centers. It could also occur on account of trauma or heterotopic ossification in synovial tags

9. can you name few?
-Os centrale is between scaphoid/capitate and trapezium
-Os Radiale externum located at the distal border of the scaphoid
-Os epitrapezium between scaphoid and trapezium
-Os epilunatum between scaphoid and lunate
-Os epiradial syloideum between radial styloid and waist of scaphoid
10. Will cross sectional imaging with MDCT or MRI would help in this child?
No. it is unlikely to help as we are not suspecting bone bruise or fracture