“RAMBO” Lesions: Radiographic Anomalies Missed by Orthopaedists

Orthopaedists are typically skilled diagnosticians as orthopedic training involves frequent evaluation of radiographs, but even a seasoned orthopedist has the potential to miss certain anomalies on radiographic images. Misdiagnosis can lead to morbidity, malunion, increased need for surgical procedures, or osteonecrosis of a large joint. “RAMBO” lesions, or radiographic anomalies missed by orthopaedists, are a subset of traumatic pediatric injuries that can be missed by an orthopaedist. These include transphyseal fracture of the distal humerus, Monteggia injury, entrapped medial epicondyle fracture of the elbow, hip dislocation with incongruous hip after reduction, and lower extremity ipsilateral second fractures. Radiographs of skeletally immature patients offer additional challenges in interpretation as many providers may be unfamiliar with the radiographic anatomy of younger patients. Understanding the characteristics of pediatric radiographs and a high index of clinical suspicion help prevent missing certain subtleties on radiographs. The purpose of this article is to review a few key traumatic pediatric radiographic anomalies missed by orthopaedists, deemed RAMBO lesions, with the aims of further educating highly skilled orthopaedic surgeons and preventing radiographic anomalies from being missed.