Fractures du carpe chez l’enfant à l’exception du scaphoïde isolé

Abstract

Carpal fractures in children and adolescents are common. However, most of them occur in the scaphoid and other carpal fractures are rare in this age group. The aim of this study is to report the outcome in a larger series and to identify risk factors for an unfavourable outcome. Patients below the age of 16 years presenting to one of the 3 participating centers with a wrist fracture involving at least one carpal bone other than the scaphoid between 2000 and 2015 were included. Open injuries and isolated scaphoid fractures were excluded. Thirty-three patients with a mean age of 13.1 years (8.5–15.6) sustained uncommon wrist fractures in 35 hands. Twenty-five wrists had just one fractured bone, affecting the trapezium (8), capitatum (6), triquetrum (4), hamatum (3), trapezoideum (2) and pisiform (2). Ten wrists had multiple carpal fractures, affecting the scaphoid (9), capitatum (7), lunate (4), pisiform (3), trapezium (2), triquetrum (2), hamatum (2). Seven patients had associated fractures of the distal forearm and 5 had metacarpal fractures. Retrospective multicentre study. Twenty-six hands had a spica cast immobilization only and 9 were treated surgically. Two dislocated capitate fractures had an open reduction, one with K-wire immobilization, the other with an external fixator due to multiple CMC luxations and a distal forearm fracture. Two perilunar fracture dislocations had open reduction and K-wires. Three trapezium fractures and two hands with multiple carpal fractures had closed reductions and K-wires. A radiological union of all fractures was documented within 7 weeks. All patients returned to full, unlimited activity. Four patients complained of mild pain under maximum load at work or at sports. Three of them had sustained comminuted trapezium fractures, the other combined capitatum and scaphoid fractures. Two patients had early degenerative changes at the last X-ray follow-up, both after closed reduction and immobilization of comminuted trapezium fractures with K-wires. All carpal fractures united reliably, irrespective to their mode of treatment. Persistent pain in daily activities or early degenerative changes were found in trapezium fractures only. Similar results were found after open reduction and internal fixation of capitate fractures with only one patient with little pain at maximum load. Non-dislocated carpal fractures in children have a particularly favorable course and heal reliably. Dislocated trapezium fractures predispose to persistent pain and early degenerative changes.