Period Of Immobilization Research Articles

Outcome of Fractures SOF in Children Treated with Early Hip Spica: A Prospective Study

Background: In children, femoral shaft fractures are usually treated by initial performance and durability for 3 to 4 weeks, followed by an additional period of immobilization in a hip spica cast until union occurs. However, such treatment would involve prolonged hospital stays, thereby increasing the cost and occupancy of hospital beds. Early hip spica cast application of femoral shaft fractures in children is a valuable alternative to the traditional treatment method. It allows for a short hospital stay, thereby avoiding all the problems associated with prolonged hospitalization. Methods: This prospective study was conducted on 20 patients. Multicentered based non-randomized evaluations were performed in Modernized District Hospital, Joypurhat, and Rajshahi Medical College Hospital, Rajshahi, Bangladesh, from January 2020 to April 2022. With femur shaft fractures over two years. All the children of both sexes from 2 to 12 years of age with fractures shaft of the femur presented within day one of injury. Follow-up was done in OPD for up to 6 months. The functional result was assessed according to Flynn’s scoring criteria. Results: The mean age of the patient was 5.65 years, ranging from 2 to 12 years. The male-female ratio was 3:1. The mean duration of hospital stay was 4.1 days. Radiological union in all cases was achieved in a mean time of 7.65 weeks. Full weight-bearing was possible in a mean time of 10.07 weeks. The result was excellent in sixteen patients (80%), successful in two (10%), and poor in two patients (10%). Conclusions: Early spica cast is a simple, effective, and definite treatment method with minimal complications and acceptable results in the pediatric age group.

Prescribing braces after forearm fractures does not decrease refracture rate.

Refracture is one of the most common complications of pediatric forearm fractures. One way to decrease this risk is to extend immobilization with a brace after the cast has been removed to allow for a range of motion exercises. The purpose of this study was to examine whether prescribing a brace after casting was discontinued decreased the risk of refracture. A retrospective, cohort study was performed at one level I trauma center. Girls under 10 years and boys under 12 years who sustained a forearm fracture from January 2013 to December 2018 were included. Patients with open fractures, fractures that required operative intervention, fractures involving the physis, fracture-dislocations, floating elbows, fractures in children with endocrine abnormalities, and fractures in patients lost to follow-up were excluded. The primary endpoint was a refracture within 6 months of the original injury that extended through the original fracture site. In total 2093 patients met the inclusion criteria. There were 19 refractures (0.9%). There was no statistically significant difference in the refracture rate between the braced (11/1091) and unbraced (8/1002) cohorts (Fisher exact value 0.65 at P < 0.05). The most common fracture type that went on to refracture was greenstick fractures. This large, retrospective study aimed to examine whether prescribing a brace had any significant effect on the refracture rate. Bracing after the cast is removed may help ease family anxiety and extend the period of immobilization while allowing for hygiene and range of motion, but it does not significantly decrease the rate of refracture.

Secreted Protein Acidic and Rich in Cysteine as an Exercise-Induced Gene: Towards Novel Molecular Therapies for Immobilization-Related Muscle Atrophy in Elderly Patients.

Long periods of immobilization, among other etiologies, would result is muscle atrophy. Exercise is the best approach to reverse this atrophy. However, the limited or the non-ability to perform the required physical activity for such patients and the limited pharmacological options make developing novel therapeutic approaches a necessity. Within this context, secreted protein acidic and rich in cysteine (SPARC) has been characterized as an exercise-induced gene. Whereas the knock-out of this gene leads to a phenotype that mimics number of the ageing-induced and sarcopenia-related changes including muscle atrophy, overexpressing SPARC in mice or adding it to muscular cell culture produces similar effects as exercise including enhanced muscle mass, strength and metabolism. Therefore, this piece of writing aims to provide evidence supporting the potential use of SPARC/SPARC as a molecular therapy for muscle atrophy in the context of immobilization especially for elderly patients.

Clinical Behavior of General Practitioners for Patients who Underwent an Operative or Conservative Treatment for a Craniocervical Fracture

Craniocervical fractures are socially important pathology. They represent one-third of the fractures in the cervical region. It is typical that elderly patients suffer from low-energy traumas such as falls, while younger patients suffer from high-energy traumas such as motor vehicle accidents, sport falls and etc. Craniocervical fractures are associated with an increased risk of craniocervical instability or neurological deficit. Primary therapeutic options depend on the type of fracture. Predictors of nonunions are the displacement of fractures, patients’ age, and comorbidities. The observership of the general practitioner in the postoperative period or the period of cervical immobilization could recognize possible malpositioning of the instrumentation, nonunion of the fracture, malsanation of the wound, and possible complications in case of the external immobilization. There is a lack of information on that topic. The goal of the paper is to summarise the most common fractures of the craniocervical region, their etiology, and treatment options and to present the results of our study of patients who underwent operative treatment for craniocervical fracture(s). Mastering the details, the treatment options, and the possible complication of the fractures in the craniocervical region, general practitioners could play an important role in the treatment of patients.

Use of a 3D-printed splint for the treatment of distal radius fractures: A randomized controlled trial

BackgroundManagement of distal radius fractures typically includes a period of immobilization with either a cast or a splint. Traditional immobilization methods can have inconveniences such as poor resistance to water and poor ventilation, which can result in skin maceration, skin breakdown, and infection in case of wetting. Hypothesis3D-printed splints could potentially overcome the inconveniences of traditional casts. In this report, we compare a 3D-printed splint (3DPS) with a conventional removable splint (CRS) and a traditional cast in a randomized clinical trial. Patients and methodsThirty-four patients with a recent distal radius fracture were randomized to receive either a 3DPS or a CRS. An additional subset of nine patients benefitted from both splints for a direct comparison. Primary outcomes were measured based on a subjective assessment questionnaire and a clinical outcome. ResultsThere was no statistical difference in the subjective assessment between the 3DPS and the CRS groups. Based on the clinical assessment, patients with the 3DPS experienced more pressure-related pain. Among the sub-sample of nine patients that benefited from both splints, eight preferred the CRS and one chose the 3DPS. The 3DPS was judged better for perspiration, coolness, and water resistance. DiscussionThe 3DPS was successful in solving shortcomings of conventional splints and cast (better ventilation, less perspiration, less warmness, more durability and water resistance). However, the rigid structure and sharp edges made it less comfortable, overall favouring the CRS. Level of evidenceII.

The Effects of Early Range of Motion Versus Immobilization Following Acute First-Time Lateral Patellar Instability Episode: Randomized Control Trial

Background:The acute management of lateral patellar dislocations (LPD) typically consists of placing the patient in a knee immobilizer for 2 to 6 weeks, but it is not clear on how long these patients should be immobilized, if at all.Hypothesis/Purpose:The purpose of this study is to compare outcomes for patients following a rehabilitation protocol that is initiated with or without a short period of immobilization after sustaining a LPD.Methods:An IRB-approved prospective study was performed at a children’s hospital which included patients <18 years of age (mean = 14.22) diagnosed with LPD (<10 days). A total of 18 (14 females, 4 males) patients diagnosed with LPD were consented and enrolled in the study (Early ROM group = 11, Immobilization group = 7). Inclusion criteria for the study was history of knee instability, effusion or history of effusion, and (+) apprehension. Subjects were followed for 4 weeks and the following outcomes were assessed: knee ROM, isokinetic strength, Kujala, Pedi-IKDC, and Y balance scores. Split-plot (2x2) ANOVAs were conducted for each of the dependent variables with an alpha level set at .05 for the global tests and independent t-tests were run at baseline and 4 weeks.Results:There were no significant differences between groups at baseline. Knee flexion ROM showed a significant main effect of time (p≤.0005) and group (p=.012). Pedi-IKDC showed a significant main effect of time (p≤.0005) and group (p=.026). When comparing groups at 4 weeks, the early ROM group had significantly better scores in both the Kujala (means for both groups: 76.78 and 52.67), p=.049)), and the Pedi-IKDC (means for both groups: 68.85 and 40.88), p=.025)). There were no significant differences in isokinetic strength measures between the groups except for affected side knee flexion at 60 degrees/sec (p=.039) with the early ROM demonstrating higher strength. In addition, the affected side composite Y-balance scores were significantly better for the early ROM group (as compared to the immobilization group) at p=.031.Conclusion:Patients that underwent early ROM following LPD scored significantly better across patient derived outcome measures and functional outcomes at 4 weeks following the initial physical therapy evaluation when compared to a group that underwent a 2 week period of immobilization. Future studies should analyze longer term comparisons between groups to determine if this short term difference leads to long term differences or improved re-injury rates.

Integrated manual therapy program along with exercise training for the rehabilitation of lateral ankle sprain: A case report

Lateral ankle sprain is most common injury occurred during sports after forceful inversion. A comprehensive rehabilitation protocol is needed for faster recovery and avoiding recurrence. A case of 23-year-old male, amateur football player, had an injury to his left ankle. He developed sudden onset of pain, swelling and was not able to bear weight on his left ankle. Orthopaedic doctor suggested him 6 weeks of immobilization in plaster cast after confirmation of anterior talo-fibular ligament grade III and Posterior talo-fibular ligament and Deltoid ligament grade I sprain on MRI. After cast removal, he was referred to physiotherapy. The patient presented with pain, swelling, decrease muscle strength, kinesiophobia and incomplete ROM of the left ankle joint. A customized physiotherapy protocol was followed for 12 weeks after immobilization period. Phase wise integrated manual therapy program along with exercise training showed significant improvement in ankle joint function after lateral ankle sprain.

Improving skeletal muscle insulin sensitivity via beta2 -agonist administration: a promising strategy to counteract metabolic disease and muscle loss.

Improving skeletal muscle insulin sensitivity via beta2 -agonist administration: a promising strategy to counteract metabolic disease and muscle loss.

Development of a cell-free strategy to recover aged skeletal muscle after disuse.

Extended periods of bed rest and limb immobilization are required for healing post-injury or disease, yet disuse can result in significant muscle atrophy and decreased quality of life in older adults. Physical rehabilitation is commonly prescribed to recover these deficits, yet accumulation of reactive oxygen species and sustained rates of protein degradation persist during the rehabilitation period that can significantly delay or prevent recovery. Pericytes, considered the primary mesenchymal and vascular stromal cell in skeletal muscle, secrete beneficial factors that maintain baseline muscle mass, yet minimal information exists regarding the pericyte response to disuse and recovery. In the current study, single-cell RNA sequencing and functional assays were performed to demonstrate that pericytes in mouse skeletal muscle lose the capacity to synthesize antioxidants during disuse and recovery. This information was used to guide the design of a strategy in which healthy donor pericytes were stimulated with hydrogen peroxide (H2 O2 ) to produce small extracellular vesicles (sEVs) that effectively restored myofibre size in adult and aged muscle after disuse. Proteomic assessment detected 11 differentially regulated proteins in primed sEVs that may account for recovery of muscle, including proteins associated with extracellular matrix composition and anti-inflammatory and antioxidant processes. This study demonstrates that healthy H2 O2 -primed pericyte-derived sEVs effectively improve skeletal muscle recovery after immobilization, presenting a novel acellular approach to rebuild muscle mass in older adults after a period of disuse. KEY POINTS: Previous studies suggest that prolonged oxidative stress is a barrier to skeletal muscle recovery after a period of immobilization. In this study we demonstrate that muscle-resident perivascular stromal cells (pericytes) become dysfunctional and lack the capacity to mount an antioxidant defence after disuse in mice. Hydrogen peroxide treatment of healthy pericytes in vitro simulates the release of small extracellular vesicles (sEVs) that effectively recover skeletal muscle fibre size and extracellular matrix remodelling in young adult and aged mice after disuse. Pericyte-derived sEVs present a novel acellular strategy to recover skeletal muscle after disuse.

Incidence of Venous Thromboembolism in Patients Receiving Anticoagulation for Foot and Ankle Surgery

Venous thromboembolism (VTE) is a serious medical condition that can be an unfortunate complication arising from foot and ankle surgery. Many factors may predispose a patient to a VTE event including prolonged postoperative immobilization, comorbidities, extended length of tourniquet time, and higher risk surgeries. Unfortunately, there is no clinical consensus for guidelines on VTE prophylaxis following foot and ankle surgery. In this retrospective cohort study, we present our patient population who were prophylactically anticoagulated following foot and ankle surgery along with their incidence of deep vein thrombosis and pulmonary embolism (PE). Included in the study were patients who had undergone elective and traumatic foot and ankle surgery from June 2017 to December 2018. Using retrospective data obtained we compared patient demographics, surgery type, length of tourniquet time, postoperative immobilization, type of VTE prophylaxis, and comorbidities including history of smoking, peripheral vascular disease, bleeding disorders, and patients undergoing dialysis. Five of 425 (1.2%) patients were diagnosed with a deep vein thrombosis and 1 of 425 (0.2%) patients was diagnosed with a pulmonary embolism. Risks factors statistically significant for developing a VTE in our patient population included extended periods of immobilization and an increasing patient age. We were able to conclude that routine prophylaxis for elective and traumatic foot and ankle surgery is both effective and safe for especially in older patients requiring extended immobilization. It's also important to take into consideration comorbidities, smoking history, tourniquet time, and the type of surgery that is being performed.

Post-operative rehabilitation following traumatic anterior shoulder dislocation: A systematic scoping review.

This systematic scoping review aimed to describe the content of post-operative rehabilitation programmes, and outcome measures selection following stabilisation surgery for traumatic anterior shoulder dislocation (TASD). An electronic search of Medline, EMBASE, CINAHL and AMED was conducted (2000-2021). Any cohort or clinical trial of patients receiving post-operative TASD rehabilitation were included. Study selection, data extraction and quality appraisal were undertaken by two independent reviewers. Twelve studies including fourteen treatment programmes were eligible. Period of post-operative immobilisation ranged from 1 day to 6 weeks, with exercise introduced between 1 and 7 weeks. Strengthening exercises were introduced between 1 and 12 weeks. Two studies described "accelerated" rehabilitation programmes, differing in immobilisation period and exercise milestones. No increased recurrence was reported in professional footballers. Two studies compared rehabilitation programmes, one not randomised, the other 18 years old. There was variability in selected outcomes measures, with only 4 studies using a common measure. There is minimal evidence to guide post-operative rehabilitation, variability in immobilisation periods and when exercise is introduced. There is no consensus on the definition of accelerated rehabilitation, or outcome measure selection. Clinical consensus of standardised terminology and stages of rehabilitation is required prior to efficacy studies.

SERUM CARTILAGE BIOMARKERS IN RESPONSE TO 21 DAYS BED REST WITH EXERCISE AND NUTRITION COUNTERMEASURES

Purpose: Immobilization is one major risk factor for osteoarthritis as longer periods of unloading can initiate catabolic processes and cause cartilage degeneration. Bed rest studies are an excellent standardized model for simulating not only the effects of spaceflight but also to investigate the impact of longer periods of immobilization and possible countermeasures to prevent articular cartilage degeneration. Biomarkers of cartilage metabolism are sensitive to changes in the biological and mechanical environment and can indicate early changes in cartilage homeostasis.

Impact of virtual embodiment and exercises on functional ability and range of motion in orthopedic rehabilitation

Recent evidence supports the use of immersive virtual reality (immersive VR) as a means of applying visual feedback techniques in neurorehabilitation. In this study, we investigated the benefits of an embodiment-based immersive VR training program for orthopedic upper limb rehabilitation, with the aim of improving the motor functional ability of the arm and accelerating the rehabilitation process in patients with a conservatively managed distal radius fracture. We designed a rehabilitation program based on developing ownership over a virtual arm and then exercising it in immersive VR. We carried out a between 3-group controlled trial with 54 patients (mean age = 61.80 ± 14.18): 20 patients were assigned to the experimental training group (immersive VR), 20 to the conventional digit mobilization (CDM) training control group, and 14 to a non-immersive (non-immersive VR) training control group. We found that functional recovery of the arm in the immersive VR group was correlated with the ownership and agency scores over the virtual arm. We also found larger range of joint movements and lower disability of the fractured arm compared with patients in the Non-immersive VR and CDM groups. Feeling embodied in a virtual body can be used as a rehabilitation tool to speed up and improve motor functional recovery of a fractured arm after the immobilization period.

Risk Factors for Loss of Reduction After Open Reduction and Internal Fixation of Isolated Olecranon Fractures in Adults.

We sought to determine whether any relevant patient, fracture, surgical, or postoperative characteristics are associated with loss of reduction after plate fixation of isolated olecranon fractures in adults. Patients who underwent open reduction and internal fixation of an olecranon fracture at our institution over an 11-year period were analyzed. Electronic patient charts and radiographic images were reviewed to gather patient, fracture, surgical, and postoperative data. Statistical analysis to explore the differences between groups was performed. Seven of 96 patients experienced a loss of fracture reduction diagnosed at a median of 19 days after their initial surgery (range: 4-116 days). The radiographic mode of failure of all patients who lost reduction was proximal migration of the proximal fracture fragment with or without implant failure. The group that lost reduction had a significantly smaller proximal fragment (14.2 vs 18.6 mm), a higher incidence of malreduction with a persistent articular step-off greater than 2 mm (6/7 vs 14/89), a greater distance between the most proximal screw and the olecranon tip (19.8 vs 13.5 mm), a higher proportion of constructs with screws placed outside of the primary plate (4/7 vs 14/89), and a higher proportion of patients that were not immobilized postoperatively (3/7 vs 8/89). Our results suggest anatomical reduction at the articular surface and adequate fixation of the proximal fragment are key factors in maintenance of reduction, with smaller proximal fragments being at higher risk for failure. A period of postoperative immobilization may decrease the risk of loss of reduction.

Rotura bilateral do tendão rotuliano (clínica case)

Simultaneous bilateral rupture of the patellar tendon is a rare entity. In this paper we describe the case of a bilateral rupture of the patellar tendon because of an indirect trauma to both knees. He was a healthy individual with no important identifiable risk factors. Surgical treatment consisted of tendon reinsertion through longitudinal bone tunnels in the patella, temporarily protected with discharge cerclage in the form of a tension band. He maintained a short period of immobilization with articulated knee braces, with a progressive increase in the allowed flexion. Ten weeks after the operation, the discharge cerclage was removed. The return to sports activity was allowed six months after surgery. In this work, we also make a brief review of the etiopathogenic factors identified in the literature.

Optimization of a pericyte therapy to improve muscle recovery after limb immobilization.

Extended bed rest or limb immobilization can significantly reduce skeletal muscle mass and function. Recovery may be incomplete, particularly in older adults. Our laboratory recently reported that vascular mural cell (pericyte) quantity is compromised after immobilization and appropriate replacement immediately before remobilization can effectively recover myofiber size in mice. Identification of a single cell surface marker for isolation of the most therapeutic pericyte would streamline efforts to optimize muscle recovery. The purpose of this study was to compare the capacity for neural/glial antigen 2 (Cspg4/NG2+) and melanoma cell adhesion molecule (Mcam/CD146+) positive pericytes to uniquely recover skeletal muscle post-disuse. A single hindlimb from adult C57BL/6J mice was immobilized in full dorsiflexion via a surgical staple inserted through the center of the foot and body of the gastrocnemius. Fourteen days after immobilization, the staple was removed and pericytes, either NG2+CD45-CD31-[Lin-], CD146+NG2-Lin-, or CD146+Lin- pericytes, were injected into the atrophied tibialis anterior (TA) muscle. TA muscles were excised 14 days after transplantation and remobilization. Pericyte transplantation did not significantly improve muscle mass or myofiber cross-sectional area (CSA) after 14 days of remobilization. However, injection of CD146+ pericytes significantly increased Type IIa quantity, capillarization, and collagen remodeling compared with NG2+ pericytes (P < 0.05). Our results suggest that selection of pericytes based on CD146 rather than NG2 results in the isolation of therapeutic mural cells with high capacity to positively remodel skeletal muscle after a period of immobilization.NEW & NOTEWORTHY In this study, pericytes were isolated from mouse skeletal muscle based on cell surface marker expression of neural/glial antigen 2 (NG2) or melanoma cell adhesion molecule (Mcam/CD146) and then compared for the capacity to recover skeletal muscle after a period of immobilization in recipient mice. We report that CD146+Lin- pericytes exhibit higher capacity than NG2+Lin- pericytes to recover Type IIa fiber quantity, capillary content, and collagen turnover after disuse.

Long-Term Changes in Sarcopenia and Body Composition in Diabetes Patients with and without Charcot Osteoarthropathy.

Background Charcot osteoarthropathy of the foot (COA) can currently only be treated using prolonged periods of immobilization of the affected extremity. Therefore, the hypothesis is that COA leads to altered body composition and increased sarcopenia. Objective To investigate the changes over several years in sarcopenia, body composition, and fat distribution in diabetes patients with previous COA compared to diabetes patients without previous COA. Methods Prospective observational clinical study. Twenty-one subjects were included and had two DXA scans done with mean 8.6-year intervals to compare changes in lean mass and fat distribution. The lean mass of limbs was used as an estimate of appendicular lean mass (aLM). Fat mass and aLM were then used to detect sarcopenic individuals using different methods. Results and Conclusions. As compared to baseline, both groups had significant loss of lean mass, and diabetics without COA had significant gain of total fat percentage. No statistically different prevalence of sarcopenia between the groups could be established. Likewise, no difference was found in total lean and fat mass changes. None of the groups had statistically significant changes of android fat distribution. As compared with published data on sarcopenia, people with diabetes might be more prone to sarcopenia than healthy individuals.

Comparison of Core Muscle Asymmetry Using Spine Balance 3D in Patients with Arthroscopic Shoulder Surgery: A STROBE-Compliant Cross-Sectional Study

Background and Objectives: Joint immobilization after shoulder surgery can cause an imbalance in the periscapular muscles and affect the kinetic chain throughout the body. There is a difference in core muscle stability because of the asymmetry of the lower extremity muscles. However, the difference due to the asymmetry of the upper-extremity muscles has not been studied extensively. The purpose of this study is to investigate the effect of joint immobilization on the symmetry of the core muscles involved in proximal stability for distal mobility. Materials and Methods: Fifty-five patients who underwent arthroscopic shoulder surgery participated in this study. Core muscle asymmetry (CMA) was measured using a body tilt device. The evaluation variables were analyzed according to the surgical site based on the direction of the core muscle ratio and core muscle state ratio. Results: No differences in CMA were found based on the surgical site (p > 0.05). As a result of the additional subanalysis, significant differences in sex and postoperative day were established (p < 0.05). CMA was low during the intensive postoperative rehabilitation period. However, sex-related differences were greater in males than in females. Conclusions: The clinical results suggest that core muscle training is necessary to reduce CMA during rehabilitation after the immobilization period has elapsed.

Fractures in Osteogenesis Imperfecta: Pathogenesis, Treatment, Rehabilitation and Prevention.

Fractures in patients with osteogenesis imperfecta (OI) are caused by a decreased strength of bone due to a decreased quality and quantity of bone matrix and architecture. Mutations in the collagen type 1 encoding genes cause the altered formation of collagen type I, one of the principal building blocks of bone tissue. Due to the complexity of the disease and the high variation of the clinical problems between patients, treatment for these patients should be individually tailored. In general, short immobilization periods with flexible casting material, use of intramedullary implants, and simultaneous deformity correction are preferred. Multidisciplinary care with a broad view of the support needed for the patient and his/her living environment is necessary for the optimal rehabilitation of these patients. Increasing bone strength with exercise, medication, and sometimes alignment surgery is generally indicated to prevent fractures.

Outcomes of Pediatric Scaphoid Nonunions Treated With Distal Radius Cancellous Autograft.

The optimal management of pediatric scaphoid fracture nonunions is controversial. We hypothesize that pediatric patients with scaphoid fracture nonunions will have favorable functional outcomes with the utilization of nonvascularized distal radius cancellous autograft with open reduction and internal fixation (ORIF). A review was performed from 2012 to 2017 identifying skeletally immature patients with scaphoid fracture nonunions treated with ORIF and nonvascularized distal radius cancellous autograft, including demographic data, mechanism of injury, length of time from injury to treatment, operative procedure, length of immobilization, time to union, and complications. Ten patients (9 males, 1 female) met inclusion criteria. Mean age was 14.3 SD 1.5 years. The majority of fractures were sustained during sports or secondary to a fall. Mean time between injury and orthopaedic evaluation was 33 weeks (SD 20 wk). Eight fractures occurred at the waist, and 2 occurred at the proximal pole. Four patients had a humpback deformity, and three presented with a dorsal intercalated segmental instability deformity. Nine patients were treated with a single cannulated compression screw with distal radius autograft. One patient also received a single Kirschner wire fixation in addition to a single cannulated screw and graft. Patients underwent a mean postoperative immobilization period of 14 SD 5 weeks. Two patients received a bone stimulator postoperatively. Radiographic union was documented after initial surgery in nine patients, with mean time to union of 17 SD 5 weeks. The 1 patient with persistent radiographic nonunion underwent revision fixation and repeat nonvascularized distal radius autograft, achieving union and resolution of symptoms. All patients ultimately reported full return to activity. Pediatric scaphoid fracture nonunions that undergo ORIF using nonvascularized distal radius cancellous autograft have favorable rates of consolidation and functional outcomes. Surgeons should consider this source of grafting in operative management of scaphoid nonunions in children and adolescents. Level IV, therapeutic.