Pseudarthrosis of the Scaphoid in Immature Skeletons

Abstract

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 performed in order to confirm or rule out this diagnosis. Several treatment methods have been reported and have shown good results. These include conservative plaster cast treatment, bone graft without osteosynthesis, bone graft with Kirschner wires, percutaneous screws and bone graft with compression screws. The treatment performed depends on the characteristics of the pseudarthrosis and the surgeon's experience.

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

“…Pediatric scaphoid fractures are rare injuries, 41 representing between 2 and 3% of pediatric hand and wrist injuries (►Table 2). 1,5,[7][8][9]23 It remains the most common carpal bone to be fractured in all pediatric age groups. 36 Studies revealed an incidence of 0.4 per 100,000 females and 2 per 100,000 males.…”

“…With this management, 30% of those clinically suspected fractures were proven to be true fractures. 2,5,14 Around 45% of the suspected scaphoid fractures have the diagnosis confirmed on the first follow-up, 2 weeks after the injury, and 84% are evident 5 weeks after injury. 2,7 It has also been highlighted that MRI had a negative predictive value of 100% and avoided unnecessary radiation and immobilization in 58% of patients.…”

“…7 The distal third of the scaphoid (avulsion, tuberosity or complete fractures) represent 36 to 87% of cases (►Table 7). [3][4][5][6][7]14,28,31,35,44,45 This is in direct contrast to adults, in whom 70 to 80% of fractures occur in the middle third. Proximal pole fractures occur in 0 to 6% of the pediatric scaphoid fractures 4,5,14,46 (►Table 7).…”

“…[3][4][5][6][7]14,28,31,35,44,45 This is in direct contrast to adults, in whom 70 to 80% of fractures occur in the middle third. Proximal pole fractures occur in 0 to 6% of the pediatric scaphoid fractures 4,5,14,46 (►Table 7). This can be explained by the process of enchondral ossification, which progressively occurs eccentrically from distal to proximal after the appearance of the scaphoid ossifying nucleus at 5 years and then further develops until around 13 years in females and around 15 years in males (►Fig.…”

“…3). 4,5,10,17,23,28,30,37,[44][45][46] In older teenagers, with scaphoids near complete ossification, scaphoid fractures more closely resemble the adult pattern (►Fig. 3).…”