Fractures of the Scaphoid, Capitate and Triquetrum in a Child: A Case Report

Foley, Kieran; Patel, Sandeep

doi:10.1177/230949901202000121

Cited by 10 publications

(11 citation statements)

References 12 publications

(11 reference statements)

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“…In significant injuries of hand and wrist in children, as well as in adults, a low threshold of suspicion of scaphoid fracture should be kept in mind. 29,30 In spite of the large cartilaginous cap making the diagnosis of scaphoid fractures difficult in this age group, some authors suggest that a wrist X-ray is always recommended. 2,3 It is estimated that nearly 37% of carpal fractures are missed initially due to the nonossified cartilaginous portion of carpal bones.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 It is estimated that nearly 37% of carpal fractures are missed initially due to the nonossified cartilaginous portion of carpal bones. 14,29,31 The treatment protocol followed in our tertiary pediatric hand and upper limb trauma center is to invariably immobilize the wrist in cases where there are high clinical suspicions of fracture with negative radiography until further imaging rules out or confirms fractures. In this respect, MRI is advantageous to CT due to the absence of radiation with MRI.…”

Section: Discussionmentioning

confidence: 99%

“…14 We then requested MRI to rule out or confirm fracture, which again is supported by the literature 32 as MRI imaging in children aids in quick diagnosis with early treatment and minimizes the amount of ionizing radiation exposure in children. 32 It is important to understand that MRI will better evaluate the cartilaginous portion of the growing scaphoid, which may be undetected on CT imaging or plain radiography 2,5,17,29,31,32 and will also detect associated carpal injuries. 2,5,17,29,31,32 We understand that an initial MRI is not a practical solution in all centers, due to limitations with access to MRI.…”

Section: Discussionmentioning

confidence: 99%

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Scaphoid Fractures below the Age of 10: Case Series and Review of the Literature

et al. 2020

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Background Scaphoid fractures are relatively uncommon in children, especially below the age of 10 due to the ossification of the scaphoid bone, which starts around 4 to 6 years of age and continues until 13 to 15 years of age, where pediatric scaphoid fractures peak. This makes the diagnoses challenging in this age group. Methods The primary aim of this study was to analyze prospectively collected data in managing scaphoid fractures. All cases in children up to the age of 10 years, treated in a tertiary pediatric hand and upper limb from January 2014 to June 2018 were included. Parameters studied were patient demographics, clinical presentation, mechanism of injury, investigations, type of fracture, associated injuries, treatment offered, outcomes and complications. The secondary aim was to review the literature due to the limited knowledge about these fractures in these low age groups. Results A total of 23 patients with documented scaphoid fractures in children up to the age of 10 years were found. Final diagnosis in all these patients was done with magnetic resonance imaging (MRI). The mean age was 9.8 years, with female preponderance. Scaphoid waist was the most common location. Five patients had associated fractures of the capitate and one patient had associated second metacarpal base fracture. All patients were managed nonoperatively. The average time of immobilization was 6.6 weeks (range: 4–10 weeks). A majority of patients had minor symptoms after the fracture, most likely due to the immobilization time. Conclusion Scaphoid fractures are rare in the pediatric population up to the age of 10. MRI is most often needed to confirm diagnosis. Nonoperative management of most scaphoid fractures in this age group is safe and feasible with no significant long-term morbidity. Surgical management of scaphoid fractures might be required in very selected cases. Level of Evidence This is a Level IV study.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Scaphoid Fractures below the Age of 10: Case Series and Review of the Literature

et al. 2020

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“…Occult fractures cannot by definition be diagnosed by conventional radiographs. In clinically suspected scaphoid injuries second-line investigations, including ultrasound, computed tomography (CT), bone scintigraphy and magnetic resonance imaging (MRI), may be used for the differential diagnosis of nonradiographically evident fractures and bone bruises from soft tissue injuries [31][32][33][34][35][36][37][38][39][40][41][42][43] .…”

Section: Editorialmentioning

confidence: 99%

Occult Pediatric Scaphoid Injuries

Sferopoulos

2017

International Journal of Radiology

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Fractures of the scaphoid may not be evident on the initial radiographic examination. They may be diagnosed in a late stage from the radiographic signs of bone healing. The diagnosis and treatment of children presenting with residual pain, swelling and tenderness on palpation in the anatomical snuffbox following either scaphoid injuries or distal forearm fractures after 5, at least, weeks of immobilization represent a true diagnostic dilemma. The use of a limited MRI with fat-suppression may indicate bone bruises of the carpal bones and/or of the scaphoid in these children. Prolonged immobilization and protection, until complete resolution of the clinical symptoms and signs, is the only required treatment.

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“…About 30% of paediatric scaphoid fractures will present late with chronic non-unions [27,28] . Some authors prefer immediate immobilisation without further imaging; however, the majority suggest performing an additional diagnostic examination [30][31][32] . MRI is the most favourable examination in order to minimise the dose of ionizing radiation [30] , and also suitable for ruling out anatomical variations [33,34] 4 So what should we do?…”

Section: Which Imaging Modality Is Better?mentioning

confidence: 99%

Diagnostic imaging of suspected scaphoid fractures: A literature review

Ali

Elamin

Mohamed

2016

IJDI

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The scaphoid plays a pivotal role in the movement of the wrist carpal complex. Scaphoid fractures can be difficult to assess clinically with relatively innocuous symptoms. Avascular necrosis, mal-union or non-union can complicate scaphoid fractures. Early diagnosis and treatment improves outcomes and reduces complication rates. Imaging plays a vital role in the diagnosis and management of such fractures, reducing significant long-term disability. We will discuss the different diagnostic modalities, techniques and protocols for diagnosing Scaphoid fractures.

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Fractures of the Scaphoid, Capitate and Triquetrum in a Child: A Case Report

Abstract: Carpal fractures in children are rare, especially with a combination of scaphoid, capitate, and triquetrum fractures. We report one such case in a 10-year-old boy who was successfully treated with Kirschner wires.

Cited by 10 publications

References 12 publications

Scaphoid Fractures below the Age of 10: Case Series and Review of the Literature

Scaphoid Fractures below the Age of 10: Case Series and Review of the Literature

Occult Pediatric Scaphoid Injuries

Diagnostic imaging of suspected scaphoid fractures: A literature review

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