Two cases of non-union of carpal scaphoid fractures in children

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.

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Titanium Elastic Nailing System (TENS) for Tibia Fractures in Children: Functional Outcomes and Complications

Journal of Nepal Medical Association ◽

10.31729/jnma.2847 ◽

2016 ◽

Vol 55 (204) ◽

pp. 55-60 ◽

Cited By ~ 9

Author(s):

Kapil Mani KC ◽

Parimal Acharya ◽

Arun Sigdel

Keyword(s):

Functional Outcomes ◽

Skin Irritation ◽

Limb Lengthening ◽

Delayed Union ◽

Tibial Fractures ◽

Entry Site ◽

Superficial Infection ◽

Non Union ◽

Fractures In Children ◽

Tibia Fractures

Introduction: Closed reduction and cast application is still regarded as first line treatment for pediatric tibial fractures. Over the past few decades, management of pediatric tibial fractures has shifted more towards operative intervention because of quicker recovery, shorter rehabilitation period, less immobilization, lack of stiffness of adjoining joints, and less psychological impact to the children. Flexible intramedullary nails not only fulfill the above advantage but also maintain alignment and rotation.Methods: This was a retrospective study of pediatric tibial fractures fixed with two titanium elastic nails through proximal ends of bones. Alignment of fracture, any infection, delayed union, non union, limb length discrepancy, motion of knee joint, and fracture union time were measured during follow-up examination.Results: Forty-five patients were enrolled into the study out of which 28 (62.2%) were male and 17 (37.8%) were female. Average age of patient was 9.48±2.17 years and average time taken to heal the fractures (both clinical and radiological) was 11.17±2.81 weeks. There were 2 (4.4%) of malunion, 4 (8.8%) of delayed union, 3 (6.6%) of limb shortening, 2 (4.4%) of limb lengthening, 6 (13.6%) of nail prominence and skin irritation, 2 (4.4%) of superficial infection at nail entry site and one case of re-fracture.Conclusions: Titanium elastic nail fixation is a simple, easy, rapid, reliable and effective method for management of pediatric tibial fractures in patients with operative indications. There may be the chances of complication following the TENS in tibia but these are avoidable as well as manageable with careful precautions. Keywords: complications; functional outcomes; tibia fractures. | PubMed

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Non-union of fractures in children who have osteogenesis imperfecta.

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-198870030-00018 ◽

1988 ◽

Vol 70 (3) ◽

pp. 439-443 ◽

Cited By ~ 25

Author(s):

J G Gamble ◽

L A Rinsky ◽

J Strudwick ◽

E E Bleck

Keyword(s):

Osteogenesis Imperfecta ◽

Non Union ◽

Fractures In Children

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Pseudoarthrosis of second metatarsal fracture

La Pediatria Medica e Chirurgica ◽

10.4081/pmc.2018.205 ◽

2018 ◽

Vol 40 (2) ◽

Author(s):

Jessica Zanovello ◽

Barbara Bertani ◽

Redento Mora ◽

Gabriella Tuvo ◽

Mario Mosconi ◽

...

Keyword(s):

Clinical Outcome ◽

Good Clinical Outcome ◽

Non Union ◽

Fractures In Children ◽

Second Metatarsal ◽

Traumatic Fracture ◽

Metatarsal Fracture ◽

Metatarsal Fractures ◽

Foot Fractures

Metatarsal fractures make up the greatest portion of foot fractures in children. Most of them are treated with closed reduction and non-weightbearing cast immobilization.Usually, these fractures heal uneventfully and delay union and pseudoarthrosis are rare. We report a case of a 10-year-old child with non-union of the second metatarsal following a traumatic fracture, caused by an accident 10 months before, and treated successfully by osteosynthesis with plate and screws. Good clinical outcome was achieved at 2 years follow-up.

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Scaphoid Fractures below the Age of 10: Case Series and Review of the Literature

Journal of Wrist Surgery ◽

10.1055/s-0040-1713800 ◽

2020 ◽

Vol 9 (06) ◽

pp. 458-464

Author(s):

Rachana Tataria ◽

Jeannette Ting ◽

Andrea Jester ◽

Tommy R. Lindau ◽

Kerstin Oestreich

Keyword(s):

Pediatric Population ◽

Age Groups ◽

Case Series ◽

Final Diagnosis ◽

Scaphoid Bone ◽

Age Group ◽

Level Of Evidence ◽

Scaphoid Fractures ◽

Fractures In Children ◽

Common Location

Abstract Background Scaphoid fractures are relatively uncommon in children, especially below the age of 10 due to the ossification of the scaphoid bone, which starts around 4 to 6 years of age and continues until 13 to 15 years of age, where pediatric scaphoid fractures peak. This makes the diagnoses challenging in this age group. Methods The primary aim of this study was to analyze prospectively collected data in managing scaphoid fractures. All cases in children up to the age of 10 years, treated in a tertiary pediatric hand and upper limb from January 2014 to June 2018 were included. Parameters studied were patient demographics, clinical presentation, mechanism of injury, investigations, type of fracture, associated injuries, treatment offered, outcomes and complications. The secondary aim was to review the literature due to the limited knowledge about these fractures in these low age groups. Results A total of 23 patients with documented scaphoid fractures in children up to the age of 10 years were found. Final diagnosis in all these patients was done with magnetic resonance imaging (MRI). The mean age was 9.8 years, with female preponderance. Scaphoid waist was the most common location. Five patients had associated fractures of the capitate and one patient had associated second metacarpal base fracture. All patients were managed nonoperatively. The average time of immobilization was 6.6 weeks (range: 4–10 weeks). A majority of patients had minor symptoms after the fracture, most likely due to the immobilization time. Conclusion Scaphoid fractures are rare in the pediatric population up to the age of 10. MRI is most often needed to confirm diagnosis. Nonoperative management of most scaphoid fractures in this age group is safe and feasible with no significant long-term morbidity. Surgical management of scaphoid fractures might be required in very selected cases. Level of Evidence This is a Level IV study.

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Modified carpal box technique in the diagnosis of suspected scaphoid fractures

Acta Radiologica ◽

10.1080/j.1600-0455.2003.00064.x ◽

2003 ◽

Vol 44 (3) ◽

pp. 319-325 ◽

Cited By ~ 3

Author(s):

F. Toth ◽

S. Mester ◽

G. Cseh ◽

A. Bener ◽

J. Nyarady ◽

...

Keyword(s):

Interobserver Agreement ◽

Diagnostic Algorithm ◽

Referral Rate ◽

Radiographic Evaluation ◽

Diagnostic Modality ◽

Non Union ◽

Scaphoid Fractures ◽

Sensitivity Specificity ◽

Very High

Purpose: To establish and test the clinical efficacy of a new diagnostic algorithm with the extensive utilization of modified carpal box radiography (mX-CB) in the detection of scaphoid fractures. Material and Methods: Initial and early follow-up radiographic evaluation of 146 suspected scaphoid fractures were carried out by mX-CB. Patients with unconfirmed diagnosis were referred to CT. Patients were followed for 1 year after injury. Sensitivity, specificity and interobserver agreement of reading mX-CB images were determined statistically. Results: No non-union or avascular necrosis was seen at 1 year after the injury. 90% of the fractures were diagnosed by mX-CB, only 6.8% of the patients needed referral to CT. Sensitivity of mX-CB at initial presentation was 81.6%. Interobserver agreement was very high among evaluators of mX-CB images. Conclusion: Extensive utilization of mX-CB as primary and early follow-up investigation resulted in high initial diagnostic accuracy and low referral rate to a more expensive diagnostic modality.

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The Clinical Scaphoid Fracture: Early Computed Tomography as a Practical Approach

Annals of The Royal College of Surgeons of England ◽

10.1308/003588408x300948 ◽

2008 ◽

Vol 90 (6) ◽

pp. 488-491 ◽

Cited By ~ 19

Author(s):

Q Nguyen ◽

S Chaudhry ◽

R Sloan ◽

I Bhoora ◽

C Willard

Keyword(s):

Ct Scan ◽

General Hospital ◽

Scaphoid Fracture ◽

False Negative ◽

False Negative Rate ◽

District General Hospital ◽

X Rays ◽

Fracture Clinic ◽

Non Union ◽

Scaphoid Fractures

INTRODUCTION Up to 40% of scaphoid fractures are missed at initial presentation as clinical examination and plain radiographs are poor at identifying scaphoid fractures immediately after the injury. Avoiding a delay in diagnosis is essential to prevent the risk of non-union and early wrist arthritis. We demonstrate the use of CT scanning for the early confirmation of a scaphoid fracture. PATIENTS AND METHODS We conducted a retrospective, chronological review of patients who attended an upper limb fracture clinic from January 2001 to October 2003 in a small district general hospital. We performed a CT scan on all ‘clinical scaphoid’ patients who had negative plain X-ray films. RESULTS Overall, 70% of patients had a CT scan within 1 week of injury and not from date of accident and emergency attendance; 83% of patients had a CT scan within 2 weeks of injury. Of 118 patients identified, 32% had positive findings and 22% of ‘clinical scaphoid’ patients had scaphoid fractures. The proportion of positive findings for an acute scaphoid fracture was 68%. Additional pathologies identified on CT were capitate, triquetral and radial fractures. CONCLUSIONS Our audit shows that it is practical to perform CT on suspicious scaphoid fractures in a small district general hospital. We identified an extremely high false-negative rate for plain X-rays and demonstrate that the appropriate use of CT at initial fracture clinic attendance with ‘clinical scaphoid’ leads to an earlier diagnosis and reduces the need for prolonged immobilisation and repeated clinical review.

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