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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: March 2014 - Volume 34 - Issue 2 - p 150–154
doi: 10.1097/BPO.0000000000000102
Upper Extremity

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.

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