Jnl Wrist Surg 2020; 09(01): 002-012
DOI: 10.1055/s-0039-3401035
Special Review: Pediatric Scaphoid Nonunion
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Pediatric Scaphoid Nonunions: A Case Series, Review of the Literature, and Evidence-Based Guidelines

Kerstin Oestreich
1  Hand and Upper Limb Service, Department of Plastic Surgery, Birmingham Women's and Children's Hospital, Birmingham, United Kingdom
,
Tatiana Umata Yoko Jacomel
1  Hand and Upper Limb Service, Department of Plastic Surgery, Birmingham Women's and Children's Hospital, Birmingham, United Kingdom
,
Sami Hassan
2  Hand Unit, Chelsea and Westminster Hospital, London, United Kingdom
3  Pulvertaft Hand Centre, Kings Treatment Centre, Royal Derby Hospital, Derby, United Kingdom
,
Maxim David Horwitz
2  Hand Unit, Chelsea and Westminster Hospital, London, United Kingdom
,
Tommy Roger Lindau
3  Pulvertaft Hand Centre, Kings Treatment Centre, Royal Derby Hospital, Derby, United Kingdom
› Author Affiliations
Funding None.
Further Information

Publication History

09 August 2019

01 November 2019

Publication Date:
20 December 2019 (online)

Abstract

Background Scaphoid fractures represent less than 3% of hand and wrist fractures in the pediatric population. Nonunions are very rare. We present a case series (n = 18) of nonunions in skeletally immature children and adolescents. We further present a review of the literature on pediatric scaphoid nonunions.

Materials and Methods We reviewed the literature by searching the main databases on pediatric scaphoid nonunions, but to identify factors that lead to nonunion, we also searched for databases on scaphoid fractures. Seventy articles were found for the period between 1961 and 2019, all with level 4/5 evidence.

Results The nonunion rate of pediatric scaphoid fractures in the literature is on average 1.5%, occurring mostly as a result of missed or underdiagnosed injuries, similar to our presented case series. Half (n = 9) of the injuries in our case series were missed initial injuries, leading to scaphoid nonunions and half developed nonunions after initial treatment. We found excellent outcomes and with surgical and nonoperative management, with few complications. Not surprisingly, the duration of immobilization is longer with nonoperative management.

Conclusions Based on the literature, we recommend a period of nonoperative management before surgery in undisplaced nonunions. In displaced nonunions, open reduction and internal fixation ± bone grafting is necessary. In pediatric scaphoid fractures, similar to adult cases, we identified that suspicious scaphoid fractures should be considered for initial immobilization, and repeat X-rays and early magnetic resonance imaging (MRI) or computed tomography (CT) scans should be considered at follow-up. Immobilization time and type of plaster should be appropriate in relation to the fracture site, similar to the adult scaphoid fracture.

Level of Evidence This is a Level IV study.