Purpose or Case Report: Scaphoid fractures are well-recognized in adults where delayed diagnosis and treatment of displaced or rotated fragments can produce avascular necrosis and long-term morbidity. In children, scaphoid fractures are uncommon, particularly in the skeletally immature, with an estimated incidence of 11 per 100,000, and there is a relative paucity of published literature on its imaging characteristics and clinical prognosis. Therefore, the purpose of this study was to investigate imaging findings, fracture locations, and the clinical outcomes of scaphoid fractures in pre-teen children.
Methods & Materials: This IRB-approved, HIPAA-compliant retrospective study included 30 pre-teen children with scaphoid fractures who were identified using a report database search for “scaphoid fracture” between Dec 1, 2008 and June 30, 2019. The initial radiographic study for each subject was retrospectively reviewed and the visibility of the fracture on each available image (PA, lateral, oblique, scaphoid views), its location (distal third, middle third, or proximal third), its displacement, and any other fractures were recorded. Twenty-four children had follow-up radiography and four children had MRI studies. Demographic information and clinical outcomes were also recorded. Descriptive statistics were performed.
Results: Thirty children (16 boys, 14 girls; mean age, 9.5 + 0.6 years, range 8-10 years). Four (13.3%) children underwent 4 views of the wrist, 23 (76.7%) underwent 3 views, and 3 (10%) underwent 2 views. Four (13.3%) fractures were inconspicuous on the initial radiography. Seven (23.3%) fractures were identified on all imaging views. Half of the fractures involved the middle third (waist) and the other half involved the distal third of the scaphoid. Fracture displacement occurred in 4 (13.3%) fractures (1-2mm) and none required surgical intervention. Only 1 (3.3%) fracture underwent surgical pinning for delayed union. Two (6.6%) children had concurrent distal radius fractures. Follow-up radiography showed signs of healing in all children.
Conclusions: Scaphoid fractures in skeletally immature, pre-teen children can be radiographically occult in the acute setting and are equally as likely to involve the distal and the middle third of the scaphoid. All of these fractures demonstrated favorable healing potential.