Epidemiology of scaphoid fractures and non-unions: A systematic review

Abstract

Background The scaphoid is the most commonly fractured carpal bone in adults as well as in children. Previous studies have reported a wide range of fracture incidences. Scaphoid fractures and non-unions in children have been sparsely investigated.

Aim To perform a systematic review of the current literature on epidemiology of scaphoid fractures and non-unions in adults and children.

Methods An electronic literature search was conducted investigating all studies in the literature published between January 1989 and June 23 2020. The systematic review following the PRISMA guidelines and searching in PubMed, Embase, Web of Science and Cochrane library databases was done in June 2020.

Results 42 studies met our inclusion criteria, 6 studies were prospective, 32 were retrospective and 4 were register studies. The majority of studies relied on conventional radiographs for diagnosis. Scaphoid fractures in adults are predominately found in males with a peak incidence in the age group from 20 to 29 years. Incidence rates in males are reported from 107 to 151/100 000. Females have an earlier peak, in the age group 10 to 19 years, with an incidence from 14 to 46/100 000. Most fractures occur in the middle third of the scaphoid representing 60–69 % of cases. Scaphoid fractures in children are predominately found in boys age 12 and above, while it seldomly occur for children younger than 9 years. In adults the risk for developing a scaphoid non-union is between 2 % and 5 %, the majority affecting males and predominately located at the middle third of the scaphoid. Non-unions among children are rare and mainly due to missed or delayed diagnosis of a fracture in the middle third of the scaphoid.

Conclusion This review revealed a substantial heterogeneity among studies concerning study population, diagnosis criterial and outcome measures. Currently, evidence on epidemiology for scaphoid fractures and non-unions are low.

Zusammenfassung

Hintergrund Von allen Handwurzelknochen frakturiert das Kahnbein sowohl im Erwachsenen- als auch im Kindesalter am häufigsten. Die bisher berichteten Inzidenzraten liegen weit auseinander, wobei es kaum Angaben punkto Skaphoidfrakturen und -pseudarthrosen im Kindesalter gibt.

Ziel Systematische Literaturrecherche bzgl. der Epidemiologie von Skaphoidfrakturen und -pseudarthrosen im Erwachsenen- und Kindesalter.

Methode Mittels einer elektronischen Literaturabfrage in PubMed, Embase, Web of Science und der Cochrane Library wurden im Juni 2020 alle entsprechenden Publikationen, erschienen in englischer Sprache, zwischen Januar 1989 und dem 23. Juni 2020 erfasst und gemäß der PRISMA-Richtlinien ausgewertet.

Ergebnisse 42 Studien (6 prospektive, 32 retrospektive und 4 Registerauswertungen) erfüllten die Einschlusskriterien. In der Mehrzahl davon basierte die Diagnose Skaphoidfraktur resp. -pseudarthrose auf konventionellen Röntgenaufnahmen. Im Erwachsenenalter betreffen Skaphoidfrakturen vorwiegend Männer im Alter zwischen 20 und 29 Jahren. Die Inzidenzrate bei Männern liegt bei 107 bis 151/100 000 Männern. Der Altersgipfel bei Frauen liegt früher zwischen 10 und 19 Jahren mit einer Inzidenz von 14 bis 46/100 000. Mit 60–69 % sind die meisten Frakturen im mittleren Drittel des Kahnbeines lokalisiert. Im Kindesalter sind vorwiegend Jungs im Alter von 12 und mehr Jahren betroffen, selten unter 9 Jahren. Das Risiko zur Entwicklung einer Pseudarthrose liegt bei Erwachsenen zwischen 2 und 5 %, wiederum sind vorwiegend Männer und das mittlere Kahnbeindrittel betroffen. Im Kindesalter sind Pseudarthrosen selten und meist Folge einer nicht- oder verspätet diagnostizierten Fraktur im mittleren Drittel des Kahnbeins.

Schlussfolgerung Die ausgewerteten Publikationen wiesen große Unterschiede bzgl. der jeweiligen Studienpopulation, der Diagnosekriterien und der Beurteilung des Behandlungsergebnisses auf. Die aktuelle epidemiologische Datenlage bzgl. Skaphoidfraktur und -pseudarthrose ist bescheiden.

Key words

Scaphoid fracture - scaphoid non-union - epidemiology - incidence

Schlüsselwörter

Kahnbeinfraktur - Kahnbeinpseudarthrose - Epidemiologie - Inzidenz

Publication History

Received: 26 August 2020

Accepted: 29 August 2020

Article published online:
29 September 2020

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