Sat., 10/20/07 Pediatrics/Spine, Paper #63, 3:33 pm OTA-2007
Clinical Scaphoid Fractures in Children
Andrea Evenski, MD1 (n); Mark Adamczyk, MD2 (n); Alonna Norberg, MD3 (n);
Jon Norberg, MD4 (n); Patrick Riley, MD2 (n);
1Akron General Medical Center, Akron, Ohio, USA;
2Children’s Hospital Medical Center of Akron, Akron, Ohio, USA;
3Red River Children’s Advocacy Center, Fargo, North Dakota, USA;
4Advanced Hand & Upper Extremity Center, Fargo, North Dakota, USA
Purpose: Scaphoid fractures are the most common carpal bone fracture in children. These fractures are missed in children more often than in adults due to this rarity and difficulty with radiographic diagnosis. The accepted treatment of suspected clinical scaphoid fractures has been immobilization for 2 weeks with repeat evaluation after this time. The purpose of this study was to evaluate clinical scaphoid fractures in the pediatric population to determine the percentage with radiographically evident fractures at discharge.
Methods: We performed a retrospective chart review and a longitudinal review of children referred to orthopaedics with wrist pain secondary to trauma from January 1999 to April 2002. A total of 149 cases were included in our study. We focused on those patients with initial negative radiographic work-up but high clinical suspicion for scaphoid fracture, which included a total of 118 wrists. These patients were followed until discharge to determine the number that had gone on to true fracture.
Results: 32% of pediatric clinical scaphoid fractures went on to be diagnosed as true fractures determined by radiographic evaluation. Comparing the physical examination findings of the two groups in the longitudinal arm, those patients with volar tenderness over the scaphoid as well as pain with radial deviation were more likely to go on to true fracture.
Conclusion and Significance: A high percentage (32%) of pediatric clinical scaphoids actually become radiographically evident fractures at follow-up. Volar tenderness over the navicular and pain with radial deviation can be used as signs to increase suspicion for eventual fracture. It is recommended that all pediatric clinical scaphoid fractures be immobilized for 2 weeks with repeat radiographs and examination at 2 weeks.
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