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Background
The immature skeleton of pediatric patients lends itself to many distinctive pathologies not encountered in adults. These uniquely pediatric musculoskeletal diseases can be diagnostically challenging for trainees and unfamiliar radiologists. Furthermore, failure to accurately diagnose these conditions can result in poor outcomes secondary to lifelong deformity and disability. This educational exhibit aims to familiarize viewers with various high-yield pediatric musculoskeletal disorders.

Educational Goals / Teaching Points
This presentation will improve viewers’ recognition and understanding of musculoskeletal diseases which preferentially affect the immature skeletons of pediatric patients. After a brief review of the normal ossification process, we will challenge viewers to identify the most common, recognizable, and/or important pediatric musculoskeletal pathologies via a case-based approach with high-order boards-style multiple choice questions. Each case will be followed with a review of each disease's key clinical, pathologic, and radiologic features.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Normal bone formation occurs via primary and secondary ossification centers. As the name suggests, primary ossification centers are the first portion of a bone to begin ossifying and typically appear during prenatal development whereas secondary ossification centers develop later, typically appearing in the postnatal or adolescent years. Primary ossification centers are often central and contribute to appositional growth while secondary ossification centers occur in the epiphyses of long bones and are separated from the primary ossification center by a growth plate responsible for longitudinal growth. The apophyses are a special subset of secondary ossification centers that do not contribute to longitudinal bone growth and typically occur at tendinous or ligamentous attachments. Given the complex and often variable process of secondary ossification, it is important to be familiar with the typical timing and appearance of secondary ossification centers in pediatric patients. Variant ossification patterns may mimic disease, particularly the juvenile osteochondroses, and can lead to overdiagnosis. Juvenile osteochondroses encompass a wide variety of poorly understood growth disturbances that affect the epiphyses and apophyses of immature skeletons. Immature skeletons also have different biomechanics and fracture patterns with unique clinical implications that are important to be familiar with when interpreting pediatric imaging studies. Finally, many congenital syndromes may first manifest in pediatric populations and can therefore mimic other pediatric musculoskeletal pathologies. A knowledgeable radiologist can offer substantial value to referring clinicians and patients by accurately differentiating these complex, often similar-appearing pathologies from normal developmental variation.

Conclusion
Radiologists should be aware of these musculoskeletal diseases which preferentially affect the immature skeletons of pediatric patients because early recognition and accurate diagnosis can prompt swift intervention and reduce long-term disability.