Pediatric Fractures of the Carpal Scaphoid – A Retrospective Clinical and Radiological Study

Author(s): Huckstadt T, Klitscher D, Weltzien A, Miller LP, Rommens PM, Schier F

Source: J Pediatr Orthop 27:447-450, 2007.

Summary:

Scaphoid Fractures are relatively uncommon in children.  Non-union is less common in children compared to adults.  This study assessed twenty-two scaphoid fractures in children less than 18 years at a single institution.  Eighteen patients had acute scaphoid fractures and four presented with nonunions.  The average age of the patient was 14 years, but ranged between 9 and 17 years of age.  The acute fractures had a variety of other injuries.

Treatment consisted of casting in seventeen of the twenty-two fractures.  A short-arm cast was applied and average immobilization time was seven weeks.  Acutely unstable fractures underwent screw fixation and the four nonunions were treated by standard open reduction and screw fixation combined with bone grafting.   Follow-up consisted of x-rays and clinical examinations.  The Cooney score was used to assess clinical outcome.  Fracture union was defined by obliteration of the fracture line of 75% or more in 2 views. Fractures were also classified according to their location and orientation.

In the acute group, two fractures were located in the proximal third, twelve in the middle third, and eight in the distal third of the scaphoid. Complete healing occurred in all patients, with an average time of 7.4 weeks in the acute group and 12.2 weeks in the nonunion group.  No patient developed an infection, nerve palsy, or implant failure.  The average Cooney score was 94 points ranging from 75-100 points.  There was only one fair result according to the rating index of Cooney.  Some mild lose of motion was present.

In children, distal third scaphoid fractures are reported to be more frequent than waist fractures.  However, the increasing activity of the pediatric population and participation in high intensity sports has changed this distribution.  More and more adolescent fractures are seen in the waist, compared to the distal third.  In the pediatric population, cast immobilization remains the gold standard treatment.  In patients with nonunion, open reduction and internal fixation is preferred.  This study confirms previous studies that report an exceptional high union rate after cast immobilization for acute fractures and operative fixation for nonunions.      

Scaphoid, Fracture, Pediatric, Wrist


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J of Pediatric Ortho