Surgical treatment of pediatric scaphoid fracture nonunions.

Scaphoid fractures in the pediatric population are uncommon but can usually be successfully managed with standard immobilization techniques. However, nonunions of pediatric scaphoid wrist fractures have been reported. We present the treatment and outcome of 13 pediatric scaphoid fracture nonunions in 12 children treated over an 18-year period. The average time elapsed between time of fracture and time of surgery was 16.7 months. Four of the nonunions were treated by using the Matti-Russe procedure, and nine were treated with Herbert screw fixation and iliac crest bone grafting. The average time of follow-up was 6.9 years (range, 2-19 years). All cases went on to clinical and radiographic union. There was no statistically significant difference in range of motion or strength between the operative and nonoperative wrist. Eleven of 12 patients demonstrated an excellent rating based on the Mayo Modified Wrist score. The length of time for postoperative immobilization in the Herbert screw group was significantly less than that in the Matti-Russe group. Currently our standard approach to the treatment of scaphoid fracture nonunions in the skeletally immature patient is the use of the Herbert screw and iliac crest bone graft.

[1]  H. Watson,et al.  Scaphoid nonunion in a child: a case report. , 1995, The Journal of hand surgery.

[2]  J. Urbaniak,et al.  Bilateral non-union of the carpal scaphoid in a child. A case report. , 1995, The Journal of bone and joint surgery. American volume.

[3]  H. Watson,et al.  Examination of the scaphoid. , 1988, The Journal of hand surgery.

[4]  R. L. Linscheid,et al.  Difficult wrist fractures. Perilunate fracture-dislocations of the wrist. , 1987, Clinical orthopaedics and related research.

[5]  J. Ogden,et al.  Fracture and ischemic necrosis of the immature scaphoid. , 1987, The Journal of hand surgery.

[6]  A. Christodoulou,et al.  Scaphoid Fractures in Children , 1986, Journal of pediatric orthopedics.

[7]  T. Herbert,et al.  Management of the fractured scaphoid using a new bone screw. , 1986, The Journal of bone and joint surgery. British volume.

[8]  M. Greene,et al.  Scaphoid fractures in children. , 1984, The Journal of hand surgery.

[9]  D. Segal,et al.  Carpal scaphoid fracture and non-union in an eight-year-old child. Report of a case. , 1983, The Journal of bone and joint surgery. American volume.

[10]  J. Ireland,et al.  Two cases of non-union of fractures of the scaphoid in children. , 1983, Injury.

[11]  R. Owen,et al.  Two cases of non-union of carpal scaphoid fractures in children. , 1982, Injury.

[12]  V. Vahvanen,et al.  Fracture of the carpal scaphoid in children. A clinical and roentgenological study of 108 cases. , 1980, Acta orthopaedica Scandinavica.

[13]  M. Rosman,et al.  Non-union of carpal scaphoid fractures in children. , 1977, The Journal of bone and joint surgery. British volume.

[14]  A. W. Dunn.  Fractures and dislocations of the carpus. , 1972, The Surgical clinics of North America.

[15]  M. Hohl,et al.  Fractures of the carpal navicular: analysis of ninety-one cases and review of the literature. , 1963, The Journal of bone and joint surgery. American volume.

[16]  H. Mussbichler.  Injuries of the carpal scaphoid in children. , 1961, Acta radiologica.

[17]  O. Russe.  Fracture of the carpal navicular. Diagnosis, non-operative treatment, and operative treatment. , 1960, The Journal of bone and joint surgery. American volume.