Fractures of the scaphoid waist and subsequent nonunions are uncommon in children. The trend toward early operative fixation in adult scaphoid fractures has begun to extend into the pediatric population. This study analyzed twenty scaphoid fractures seen over a 25-year period at a single children’s hospital. All nonunions were located at the scaphoid waist and the majority of patients were males. The average age of the patients was 15 years and all had an open growth plate at the time of the scaphoid fracture. Average time between injury and surgery was 12.6 months. The imaging modality per patient was slightly different and included a combination of plain x-rays, CT scans and/or MRI. The surgical procedure was also diverse. The most common operation consisted of placement of a Herbert screw and bone graft in eleven children. One child had placement of the screw without bone graft. Six adolescents underwent fixation, utilizing bone graft but no fixation. Two children underwent placement of Kirschner wires across the fracture site, along with bone grafting. All patients were immobilized after surgery, with an average time of 3.7 months. Average follow-up time was 6 years, although three patients could not be followed. Little-to-no activity limitation was noted at follow-up and most patients appeared to be satisfied. All fracture united in the patients followed.
The authors conclude that the majority of scaphoid fractures in children heal with a small number resulting in nonunion. For a pediatric scaphoid nonunion, operative fixation leads to consistent union, although the precise recommended procedure remains unclear. With the advent of fixation devices specifically applicable to the scaphoid, internal fixation seems the most likely alternative. However, the technical aspects of the procedure (curettage, reduction, grafting, etc.) are probably more important than the fixation device chosen.
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