Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 May-Jun;42(5):260-264.
doi: 10.1097/BPO.0000000000002094.

Outcomes of Pediatric Scaphoid Nonunions Treated With Distal Radius Cancellous Autograft

James S Lin  1 , Gregory Grenier  2 , Julie Balch Samora  1   2
Affiliations

Outcomes of Pediatric Scaphoid Nonunions Treated With Distal Radius Cancellous Autograft

James S Lin et al. J Pediatr Orthop. 2022 May-Jun.

Abstract

Background: The optimal management of pediatric scaphoid fracture nonunions is controversial. We hypothesize that pediatric patients with scaphoid fracture nonunions will have favorable functional outcomes with the utilization of nonvascularized distal radius cancellous autograft with open reduction and internal fixation (ORIF).

Methods: A review was performed from 2012 to 2017 identifying skeletally immature patients with scaphoid fracture nonunions treated with ORIF and nonvascularized distal radius cancellous autograft, including demographic data, mechanism of injury, length of time from injury to treatment, operative procedure, length of immobilization, time to union, and complications.

Results: Ten patients (9 males, 1 female) met inclusion criteria. Mean age was 14.3 SD 1.5 years. The majority of fractures were sustained during sports or secondary to a fall. Mean time between injury and orthopaedic evaluation was 33 weeks (SD 20 wk). Eight fractures occurred at the waist, and 2 occurred at the proximal pole. Four patients had a humpback deformity, and three presented with a dorsal intercalated segmental instability deformity. Nine patients were treated with a single cannulated compression screw with distal radius autograft. One patient also received a single Kirschner wire fixation in addition to a single cannulated screw and graft. Patients underwent a mean postoperative immobilization period of 14 SD 5 weeks. Two patients received a bone stimulator postoperatively. Radiographic union was documented after initial surgery in nine patients, with mean time to union of 17 SD 5 weeks. The 1 patient with persistent radiographic nonunion underwent revision fixation and repeat nonvascularized distal radius autograft, achieving union and resolution of symptoms. All patients ultimately reported full return to activity.

Conclusions: Pediatric scaphoid fracture nonunions that undergo ORIF using nonvascularized distal radius cancellous autograft have favorable rates of consolidation and functional outcomes. Surgeons should consider this source of grafting in operative management of scaphoid nonunions in children and adolescents.

Level of evidence: Level IV, therapeutic.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

References

    1. Nafie SA. Fractures of the carpal bones in children. Injury. 1987;18:117–119.
    1. Brudvik C, Hove LM. Childhood fractures in Bergen, Norway: identifying high-risk groups and activities. J Pediatr Orthop. 2003;23:629–634.
    1. Christodoulou AG, Colton CL. Scaphoid fractures in children. J Pediatr Orthop. 1986;6:37–39.
    1. Chloros GD, Themistocleous GS, Wiesler ER, et al. Pediatric scaphoid nonunion. J Hand Surg Am. 2007;32:172–176.
    1. Gholson JJ, Bae DS, Zurakowski D, et al. Scaphoid fractures in children and adolescents: contemporary injury patterns and factors influencing time to union. J Bone Joint Surg Am. 2011;93:1210–1219.