What I can see on this X-ray

• Distal humerus, proximal radius and ulna are in continuity with no visible cortical break, step-off, or displaced fracture line.
• I can see a few small rounded/oval bone densities around the joint (near the capitellum/radial head and the medial side). These correspond to the normal secondary ossification centers of the growing elbow, which appear in a well-known sequence remembered by the mnemonic CRITOE: Capitellum (~1 yr), Radial head (~3-5 yr), Internal/medial epicondyle (~5-7 yr), Trochlea (~9-10 yr), Olecranon (~9-10 yr), External/lateral epicondyle (~9-10 yr). For a 6-year-old, having the capitellum, radial head, and a just-appearing medial epicondyle ossicle is expected and normal - these should not be mistaken for fracture fragments or loose bodies.

• The elbow is flexed, and the humerus-radius-ulna alignment looks preserved. The two key alignment checks radiologists use are:
  • Anterior humeral line - should pass through the middle third of the capitellum.
  • Radiocapitellar line - a line through the radial shaft should bisect the capitellum.
• From what is visible here, these relationships appear roughly maintained, without obvious anterior "sail sign" or a clear posterior fat pad (a dark triangular lucency behind the distal humerus that is always abnormal and suggests an intra-articular/occult fracture, most often supracondylar in this age group).

Overall impression

• This is a photograph of a film on a light box, not the original digital image, so fine detail (subtle hairline fractures, a subtle posterior fat pad sign, or a non-displaced lateral condyle/supracondylar fracture) can be very hard to exclude with confidence from a photo.
• Supracondylar and lateral condyle fractures are the most common elbow fractures in this exact age group (peak 5-7 years) and can be radiographically subtle even on a good-quality original film.
• Since this was already ordered by an orthopedic surgeon, the definitive read should come from their formal report combined with the clinical exam (point of maximal tenderness, swelling, range of motion, mechanism of injury).