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

Summary Pediatric hand fractures are common childhood injuries. Identification of the fractures in the emergency room setting can be challenging owing to the physes and incomplete ossification of the carpus that are not revealed in the xrays. Most simple fractures can be treated with appropriate immobilization through buddy taping, finger splints, or casting. If correctly diagnosed, reduced and immobilized, these fractures usually result in excellent clinical outcomes. However, fractures may require operative stabilization if they have substantial angulation or rotation, extend into the joint, or cannot be held in a reduced position with splinting alone. Most fractures can be treated operatively with closed reduction and percutaneous pinning if addressed within the first week following the injury. In children, the thick, vascular-rich periosteum and bony remodeling potential make anatomic reductions and internal fixation rarely necessary. Most fractures complete bony healing in 3-4 weeks, with the scaphoid being a notable exception. Following immobilization, children rarely develop hand stiffness and formal occupational therapy is usually not necessary. Despite the high potential for excellent outcomes in pediatric hand fractures, some fractures remain difficult to diagnose and treat.

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“…However, the growing carpus may retain some remodeling capacity, allowing for some correction of the malalignment over time. 48 …”

Section: Specific Injuriesmentioning

confidence: 99%

Pediatric Hand Fractures

2013

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“…The majority of these fractures are treated successfully with standard plaster cast immobilisation and nonunion rates are very low at 0.8% (Fabre et al, 2001). The healing capacity of the scaphoid in children is better than that of adults but if good treatment is not applied, nonunion may result (Hamdi and Khelifi, 2011).…”

Section: Discussionmentioning

confidence: 99%

Pediatric scaphoid nonunion treated with iliac wing bone graft and screw fixation: Two case reports

Çıraklı¹,

Pişkin²,

Çıraklı³

et al. 2013

jecm

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Article HistoryReceived 29 / 05 / 2013 Accepted 24 / 06 / 2013Scaphoid fractures are rarely seen in the pediatric age group. If the fracture is diagnosed late or appropriate treatment is not applied, it may result in nonunion. Wrist pain and restricted movements in these school age cases lead to problems in the developmental activites of the children. Therefore, with the aim of a speedy return to activity, the two pediatric cases presented here were treated with iliac wing bone graft and screw fixation and the results were successful in conformity with literature. As these fractures are rarely seen, it was aimed to evaluate these cases with the relevant literature.

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“…However, for children, there is still some controversy regarding the best protocol to follow (2) . 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.…”

Section: Treatment and Controversiesmentioning

confidence: 99%

“…This author believed that, for children, there was no need for osteosynthesis because their potential for cure was greater than that of adults. Hamdi and Khelifi (24) and Maxted and Owen (25) believed that using Kirschner wires on the bone graft was useful for achieving union and that this method was an important addition for the procedure. Waters and Stewart (14) recommended the use of vascularized bone grafts in association with internal fixation for cases of avascular necrosis and pseudarthrosis of the scaphoid in immature skeletons.…”

Section: Diagnosis Through Imagingmentioning

confidence: 99%

“…Unlike what occurs in adults, fractures of the scaphoid in children affect the distal pole in 59 to 87%, the middle portion in 12 to 36% and the proximal pole in 0 to 2%. Children also present a very low rate of pseudarthrosis (0.8%) (1,2,(4)(5)(6) . Taleisnik and Kelly (7) reported that the vascular supply of the scaphoid does not change with growth.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pseudoartrose do escafoide em esqueleto imaturo

Lemos¹,

Bentes²,

Neto³

et al. 2012

Rev. bras. ortop.

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This paper presents a review of the literature on pseudarthrosis of the scaphoid in skeletally immature individuals, taking into consideration its epidemiology, diagnosis and treatment, as well as its controversies. Knowledge of this subject makes it possible for patients to be given appropriate treatment immediately. Pseudarthrosis of the scaphoid in skeletally immature patients is a rare condition that results from error or lack of diagnosis of a fracture. Thus, careful clinical and radiographic examination should be Rev Bras Ortop. 2012;47(3):292-96

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

Cited by 13 publications

References 13 publications

Pediatric Hand Fractures

Pediatric Hand Fractures

Pediatric scaphoid nonunion treated with iliac wing bone graft and screw fixation: Two case reports

Pseudoartrose do escafoide em esqueleto imaturo

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