You could be reading the full-text of this article now if you...

If you have access to this article through your institution,
you can view this article in

The Pediatric Fracture of the Scaphoid in Patients Aged 13 Years and Under: An Epidemiological Study

Ahmed, Issaq BEng (Hons), FRCSEd (Tr & Orth); Ashton, Fiona MBChB; Tay, Wy Keat MRCS; Porter, Daniel FRCSEd (Tr & Orth)

Journal of Pediatric Orthopaedics:
doi: 10.1097/BPO.0000000000000102
Upper Extremity
Abstract

Background: Fractures of the scaphoid are uncommon in the pediatric population. Despite their rarity, a significant number of children are referred to the fracture clinic for a suspected scaphoid fracture. The aim of this study was to report on the current incidence, pattern of injury, and the long-term outcomes following this injury in the pediatric population.

Methods: Analysis of all pediatric scaphoid fractures presenting to a tertiary pediatric hospital (aged 13 y and under) over a 5-year period was performed. The case notes, radiographs, and other imaging studies for these patients were reviewed. Long-term functional outcome was assessed using Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.

Results: Fifty-six patients of the 838 (6.7%) referred for a suspected scaphoid fracture were identified as having a confirmed diagnosis of a scaphoid fracture, giving an average annual incidence of 11 per 100,000. This group consisted of 39 boys (70%) and 17 girls (30%). The average age of incidence in boys was 12.2 years and in girls was 10.3 years (P<0.001). No scaphoid fractures were observed in boys below the age of 11 years and in girls below the age of 9 years. The most common type of fracture was a distal pole fracture (45 patients). One patient sustained a proximal pole fracture and went on to develop a nonunion. The duration of treatment in cast was shorter in distal pole fractures than in other types (P<0.001). At a mean follow-up of 70 months (range, 46 to 104 mo), 60% reported no limitation or impact when reporting a range of daily functional activities (mean DASH score=3.0).

Conclusions: There is a suggestion that the overall incidence of scaphoid fractures in the pediatric population is increasing, but children aged 13 years and under continue to maintain a distinct fracture pattern when compared with adolescents and adults. The majority involves the distal third of the scaphoid and carries a good prognosis with conservative management.

Level of Evidence: Prognostic study, Level 4.

Author Information

The Royal Hospital of Sick Children, Edinburgh, Scotland, UK

The authors declare no conflicts of interest.

Reprints: Issaq Ahmed, BEng (Hons), FRCSEd (Tr & Orth), The Royal Hospital for Sick Children, 9 Sciennes Road, Edinburgh EH9 1LF, Scotland, UK. E-mail: issaq.ahmed@rcsed.net.

© 2014 by Lippincott Williams & Wilkins