Little is known about longer-term functional outcomes of children treated for scaphoid fractures. We hypothesized that with appropriate treatment, functional outcomes would be consistent with population norms and would not vary between patients treated with cast-immobilization versus surgery. We further hypothesized that osteonecrosis and chronic nonunion would each be independent predictors of worse functional outcomes.
Sixty-three of 312 patients (20%), age 8 to 18 years at the time of treatment, completed the Disability of the Arm, Shoulder, and Hand (DASH) inventory, DASH work and sports modules, and the Modified Mayo Wrist Score (MMWS) at a median follow-up time of 6.3 years (range, 2.6 to 17.7 y) from injury. Thirty-nine patients presented initially with acute scaphoid fractures, and 24 patients presented with chronic nonunions. Six of the 39 acute fractures and 20 of 24 nonunions were treated surgically. Univariate analysis and multivariate linear regression were used to identify predictors of MMWS and DASH scores.
All patients went on to successful bony healing. The median DASH score for the cohort was 1 (interquartile range [IQR]: 0 to 4), with more than 95% of respondents reporting functional status equivalent to or better than the general population. Multivariate analysis demonstrated that chronic fracture presentation (P<0.001) and osteonecrosis (P=0.013) were each independent predictors of a worse outcome. Results of the DASH Work and Sports Modules as well as the MMWS corroborated the results found using the DASH. Surgical treatment was not found to influence functional status. The median MMWS for both surgical and nonsurgical patients was 100, representing excellent functional outcome.
Children and adolescents with scaphoid fractures that achieve union have excellent outcomes at mid-term follow-up, with no difference in outcomes between casting and surgery. Although patients treated for nonunions and osteonecrosis have significantly decreased wrist function compared with acute fractures, the median level of function for these patients is in accordance with general population means.
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