Fracture general principles

Fracture Mimics

• Unfused epiphyseal plate (=growth plate), e.g. in the elbow and shoulder (see fig. 3b, section General)
• Unfused apophysis (=ossification center where tendon inserts). The apophysis at the base of metatarsal V is a notorious fracture mimic.
• Accessory ossification centers, particularly in the feet (fig. 9)

In all the above-described mimics, it is crucial to evaluate older images. 
Additionally, when in doubt, it is useful to consult a book of reference describing the normal variations of the skeletal system (e.g. Keats, T.E.; Atlas of Normal Roentgen Variants That May Simulate Disease). Each Emergency Assistance department should have such a (thick!) reference book.