Abstract
Background
Fractures of the scaphoid are uncommon in the paediatric 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 is to report on the incidence and pattern of injury of the paediatric scaphoid fracture and present a new classification.
Methods
An analysis of all paediatric scaphoid fractures treated in the Royal Hospital for Sick Children, Edinburgh (age up to 14 years old) over a five year period. The case notes, radiographs and were applicable MRI scan for these patients were reviewed. The clinical information recorded included the dominant hand, mechanism of injury, clinical features on examination, type of cast and length of period, stiffness following cast removal and evidence of delayed or non union. Each radiograph was analysed independently and fracture classified according to a new classification system.
Results
56 patients out of the eight hundred and thirty eight (6.7%) referred were identified who had a confirmed diagnosis of a scaphoid fracture on both clinical and radiological assessment. This group consisted of 39 males (70%) and 17 females (30%). The average age of incidence in males was 12.2 years (range 11 to 13 years) and females was 10.3 years (range 9 to 10 years). There were no scaphoid fractures seen in males below the age of 11 years and in females below the age of 9 years. The commonest type of injury was a distal pole fracture (33 patients). One patient sustained a proximal pole fracture and went onto develop a non-union.
Conclusions
Scaphoid fractures in children have distinct epidemiological features. The majority involve the distal third of the scaphoid and heal with conservative treatment. The use of a new classification system specific to the paediatric population is beneficial when determining the optimal management of this type of injury.
