Conservative treatment of scaphoid nonunion in children and adolescents

Abstract

This is a retrospective study of six children with ununited scaphoid fractures treated conservatively. Their mean age was 12.8 years (9.7 to 16.3). Five had no early treatment. Radiological signs of nonunion were found at a mean of 4.6 months (3 to 7) after injury. Treatment consisted of cast immobilisation until clinical and radiological union. The mean clinical and radiological follow-up was for 67 months (17 to 90). We assessed the symptoms, the range of movement of the wrist and the grip strength to calculate the Modified Mayo Wrist score. The fracture united in all patients after a mean period of immobilisation of 5.3 months (3 to 7). Five patients were pain free; one had mild pain. All returned to regular activities, and had a range of movement and grip strength within 25% of normal, resulting in an excellent Modified Mayo Wrist score. Prolonged treatment with cast immobilisation resulted in union of the fracture and an excellent Modified Wrist Score in all patients.

Excellent Results After Bone Grafting and K-Wire Fixation for Scaphoid Nonunion Surgery in Skeletally Immature Patients

“…It is difficult to identify the limited number of patients where late spontaneous healing can occur in a plaster cast. A recent study from Boston on scaphoid fractures in patients younger than 18 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) years supports this view. When cast treatment started immediately after injury, 90% (181/201) of the fractures healed compared with only 23% (18/77) when it started more than 6 weeks later ("chronic scaphoid fractures").…”

“…Six patients (mean age 12.8 years old) from 3 hospitals initiated cast treatment 3-7 months after sustaining a scaphoid fracture. 16 Only one patient was diagnosed at the time of injury, but he received an "inadequate period of cast treatment" according to the authors, and the length was not given. These fractures all healed after 3-6 months of cast therapy.…”

Operative management of nonunion scaphoid fracture in children: a case report and literature review

“…The treatment is often surgical, all series showed successful results with operative management of scaphoid fracture nonunion in children. Because a child's scaphoid has a more favourable healing capacity than that of an adults, Weber et al [12] proposed prolonged treatment with cast immobilisation for nonunion scaphoid fractures in children.…”

Pseudoartrose do escafoide em esqueleto imaturo

“…Several methods have been reported to present good results, including conservative treatment with plaster casts, bone grafts without osteosynthesis, bone grafts with Kirschner wires, percutaneous screws and bone grafts in association with compression screws (1,4) . Weber et al (18) proposed prolonged treatment with plaster-cast immobilization for pseudarthrosis of the scaphoid in the cases of six children, for a mean period of five months (i.e. until consolidation was attained).…”