Scaphoid fractures in children: diagnosis and treatment

Abstract

Objective To summarize the experience of diagnosis and treatment of scaphoid fractures in children, and provide a reliable and predictable program for the pediatric scaphoid fractures. Methods Twelve children with scaphoid fractures were treated conservatively or surgically, involving 9 boys and 3 girls with an average age of 12. 5 years (ranged from 10 to 15 years). Among them, 1 case was identified as type A1, 3 as A2, 1 as B2, 2 as B2, 1 as B3, 3 as D1 and 1 as D2, according to the modified Hetbert classification system. Four patients with acute stable fracture, 2 with acute unstable fracture and 2 with type D1 fracture were treated conservatively with cast immobilization, whereas a patients with type B2 fracture with displacement more than 1mm, one with type B3 and another one with type D2 were treated surgically with open reduction and internal fixation, percutaneous DTJ cannulated screw fixation, and screw fixation with bone grafting, respectively. Results All the patients treated with cast immobilization achieved bone union at mean 7. 2 weeks (range, 6 to 9 weeks) and pain relief was obtained in all eases with the grip strength to 91% (rang, 86% to 96%) and rang of motion (ROM) recovered to 93% (rang, 87% to 100%), both of which were compared with the healthy side, The other 4 cases treated surgically achieved bone union at mean 7. 8 weeks (5 weeks for type B2, 5. 5 weeks for type B3, 7 weeks for type D1, and 12 weeks for type D2) postoperatively and pain relief was obtained in all cases except for one mild wrist pain. The grip strength and ROM recovered to 90% (rang, 84% to 94%) and 91% (rang, 83% to 97%) respectively, compared with the healthy side. No postoperative complications occurred. Conclusions Clinical and radiological presentations are subtle in pediatric scaphoid fractures, early precise diagnosis and accurate cast immobilization play an important role in prevention of nonunion. Screw fixation with bone graft is an efficient alternative to treat nonunion of pediatric scaphoid fracture. Key words: Children; Pediatric; Scaphoid fractures