Abstract
Background Scaphoid fractures represent less than 3% of hand and wrist fractures in the pediatric
population. Nonunions are very rare. We present a case series (n = 18) of nonunions in skeletally immature children and adolescents. We further present
a review of the literature on pediatric scaphoid nonunions.
Materials and Methods We reviewed the literature by searching the main databases on pediatric scaphoid
nonunions, but to identify factors that lead to nonunion, we also searched for databases
on scaphoid fractures. Seventy articles were found for the period between 1961 and
2019, all with level 4/5 evidence.
Results The nonunion rate of pediatric scaphoid fractures in the literature is on average
1.5%, occurring mostly as a result of missed or underdiagnosed injuries, similar to
our presented case series. Half (n = 9) of the injuries in our case series were missed initial injuries, leading to
scaphoid nonunions and half developed nonunions after initial treatment. We found
excellent outcomes and with surgical and nonoperative management, with few complications.
Not surprisingly, the duration of immobilization is longer with nonoperative management.
Conclusions Based on the literature, we recommend a period of nonoperative management before
surgery in undisplaced nonunions. In displaced nonunions, open reduction and internal
fixation ± bone grafting is necessary. In pediatric scaphoid fractures, similar to
adult cases, we identified that suspicious scaphoid fractures should be considered
for initial immobilization, and repeat X-rays and early magnetic resonance imaging
(MRI) or computed tomography (CT) scans should be considered at follow-up. Immobilization
time and type of plaster should be appropriate in relation to the fracture site, similar
to the adult scaphoid fracture.
Level of Evidence This is a Level IV study.
Keywords
pediatric - scaphoid - nonunion - pseudarthrosis - outcome
