scholarly journals Spontaneous Healing of a Pediatric Scaphoid Proximal Pole Fracture Nonunion

2017 ◽  
Vol 07 (01) ◽  
pp. 081-083
Author(s):  
Nicholas Riley ◽  
Ian McNab ◽  
Neal Rupani
Keyword(s):  
Nonoperative Management ◽  
Pediatric Population ◽  
Scaphoid Fracture ◽  
Fracture Pattern ◽  
Proximal Pole ◽  
Unique Case ◽  
Scaphoid Fractures ◽  
Fractures In Children ◽  
Increased Risk ◽  
Fracture Nonunion

Background Scaphoid fractures in the pediatric population are rare. The majority of nondisplaced fractures tend to unite; however, there is an increased risk of nonunion in proximal pole fractures. Limited evidence exists in their outcomes, owing to the scarcity of the fracture pattern. Case Description A 13-year-old boy who presented late after developing a traumatic proximal pole scaphoid fracture developed nonunion. He was treated conservatively owing to it being asymptomatic and developed union at 18 months. Literature Review No previous case of proximal pole pediatric scaphoid fractures with established nonunion that has developed union with conservative management has been described. Clinical Relevance The authors highlight a unique case of an established proximal pole scaphoid nonunion in a child progressing to union with nonoperative intervention. Owing to its rarity and difficulty in obtaining research, we recommend consideration of nonoperative management of asymptomatic nondisplaced proximal pole fractures in children.

scholarly journals Pediatric Scaphoid Nonunions: A Case Series, Review of the Literature, and Evidence-Based Guidelines

2019 ◽  
Vol 09 (01) ◽  
pp. 002-012 ◽  
Author(s):  
Kerstin Oestreich ◽  
Tatiana Umata Yoko Jacomel ◽  
Sami Hassan ◽  
Maxim David Horwitz ◽  
Tommy Roger Lindau
Keyword(s):  
Nonoperative Management ◽  
Pediatric Population ◽  
Scaphoid Fracture ◽  
Case Series ◽  
Fracture Site ◽  
X Rays ◽  
Review Of The Literature ◽  
Level Of Evidence ◽  
Scaphoid Fractures ◽  
Magnetic Resonance Imaging Mri

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.

Gadolinium Enhanced Mr Assessment of Proximal Fragment Vascularity in Nonunions after Scaphoid Fracture: Does It Predict the Outcome of Reconstructive Surgery?

2004 ◽  
Vol 29 (5) ◽  
pp. 444-448 ◽  
Author(s):  
A.K. SINGH ◽  
T.R.C. DAVIS ◽  
J.S. DAWSON ◽  
J.A. ONI ◽  
N.D. DOWNING
Keyword(s):  
Internal Fixation ◽  
Reconstructive Surgery ◽  
Scaphoid Fracture ◽  
Proximal Fragment ◽  
Proximal Pole ◽  
Scaphoid Fractures ◽  
Fracture Nonunion ◽  
Fracture Nonunions ◽  
Outcome Of Surgery ◽  
Mr Scanning

This study investigated whether the outcome of bone graft and internal fixation surgery for nonunion of scaphoid fractures could be predicted by gadolinium-enhanced MR assessments of proximal fragment vascularity. Sixteen established scaphoid fracture nonunions underwent gadolinium-enhanced MR scanning before surgical treatment with bone grafting and internal fixation. No relationship was found between MR enhancement and the outcome of surgery. Union was achieved in eight of the 12 nonunions with more than 50% enhancement, and three of the four with less than 50% enhancement, of the proximal pole. Furthermore, union was achieved in both of the nonunions which had less than 25% enhancement of the proximal pole. We conclude that enhanced MR assessments of the vascularity of the proximal fragment of a scaphoid fracture nonunion do not accurately predict the outcome of reconstructive surgery.

scholarly journals Pronator quadratus pedicled bone graft for scaphoid non-unions

2020 ◽  
Vol 7 (10) ◽  
pp. 3414
Author(s):  
Harsha Vardhan ◽  
Anto Francis
Keyword(s):  
Bone Graft ◽  
Fracture Healing ◽  
Scaphoid Fracture ◽  
Fracture Site ◽  
Vascularized Bone Graft ◽  
Proximal Pole ◽  
Pronator Quadratus ◽  
Scaphoid Fractures ◽  
Fracture Nonunion ◽  
Vascularized Bone

Scaphoid fractures frequently present with nonunion and proximal pole necrosis, the treatment of which is bone grafting. Pronator quadratus pedicled vascularized bone graft is an option especially in the setting of proximal pole necrosis. We describe our experience of managing such scaphoid non-unions using pronator quadratus pedicled vascularized bone graft. Six patients were managed using pronator quadratus pedicled vascularized bone graft following scaphoid fracture nonunion with proximal pole necrosis. All patients had good fracture healing and symptom resolution. Mild deficit in wrist extension was noted in all patients. Pronator quadratus pedicled vascularized bone graft is an attractive option for managing scaphoid nonunion. Lying adjacent to the fracture site, bone can be harvested and transferred without making any other incisions. This procedure introduces another source of blood supply to the fracture site and hence improves fracture healing.

scholarly journals Outcomes of Local Bone Graft and Fixation of Proximal Pole Scaphoid Nascent Nonunions and Nonunions

2020 ◽  
Vol 09 (03) ◽  
pp. 203-208
Author(s):  
Kristin E. Shoji ◽  
F. Joseph Simeone ◽  
Sezai Ozkan ◽  
Chaitanya S. Mudgal
Keyword(s):  
Bone Graft ◽  
Common Mechanism ◽  
Study Cohort ◽  
Proximal Pole ◽  
Scaphoid Fractures ◽  
Local Bone ◽  
Case Series Study ◽  
Increased Risk ◽  
Surgical Fixation ◽  
The Mean

Abstract Background Fractures of the proximal pole of the scaphoid have an increased risk of nonunion due to its tenuous blood supply. The optimal treatment of proximal pole scaphoid nonunions remains controversial. Objectives To review a single surgeon's experience with proximal pole scaphoid nascent nonunions (delayed unions) and nonunions that underwent surgical fixation with a cannulated headless compression screw and local autologous bone graft from the distal radius. Patients and Methods After obtaining Institutional Review Board approval, the electronic medical record of one tertiary care center was queried for patients with the diagnosis of “proximal pole scaphoid fractures” who underwent surgical fixation by a single surgeon over an 11-year period (2006–2017). Fifteen patients met initial query criteria; upon review of records, four patients were excluded due to the acute nature of the fracture, and one was excluded as surgical fixation included a vascularized bone graft. Results The final study cohort consisted of 10 patients with a total of 10 proximal pole scaphoid nonunions. Almost all of the patients in this study were male (9/10 [90%]), and sporting activities were the most common mechanism of injury (8/10 [80%]). Volumetric measurements of the scaphoid fractures on computed tomography (CT) revealed that the mean total volume of the scaphoid was 2.4 ± 0.48 cm3 and the mean volume of the proximal pole fragment was 0.38 ± 0.15 cm3. Postoperative CT scans were performed at a mean of 12.4 weeks (range: 8–16 weeks), with seven (7/10 [70%]) showing signs of complete union and three (3/10 [30%]) demonstrating partial union. None of the patients required additional procedures and there were no complications. Conclusions Our results suggest that proximal pole scaphoid fractures with delayed union and nonunion treated with surgical fixation and autologous local bone graft heal without the need for more complex vascularized procedures. The volume of the proximal pole fragment did not correlate with increased risk of ongoing nonunion after the index procedure. Level of Evidence This is a Level IV, case series study.

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

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.

Association of Lunate Morphology With Progression to Scaphoid Fracture Nonunion

Hand ◽  
2020 ◽  
pp. 155894472093736
Author(s):  
Rachel E. Hein ◽  
Amanda N. Fletcher ◽  
Rose T. Tillis ◽  
Eric Q. Pang ◽  
David S. Ruch ◽  
...  
Keyword(s):  
Scaphoid Fracture ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Delayed Union ◽  
Type I ◽  
Type Ii ◽  
Fracture Location ◽  
Scaphoid Fractures ◽  
Fracture Nonunion ◽  
N 93

Background: The purpose of our study was to review a series of patients with scaphoid fractures to determine whether there was an association between lunate morphology and progression to delayed union or nonunion when treated operatively or nonoperatively. Secondary aims included evaluation of the relationship between lunate morphology and scaphoid fracture location. Methods: A retrospective review of all patients with a diagnosis of scaphoid fracture was performed at our institution between 2014 and 2017. Medical records and radiographs were evaluated to determine lunate morphology, scaphoid fracture location, treatment, and time to union. Differences between groups were determined using χ2 analysis with significance set at P <.05. Multiple logistic regression analyses were used to evaluate scaphoid union in the setting of lunate morphology when controlling for confounders. Results: A total of 169 patients were included; 45.0% (n = 76) of patients had type I lunate morphology, and 55.0% (n = 93) had type II. In all, 64.5% (n = 49) of patients with type I lunate and 68.8% (n = 64) with type II lunate had a fracture at the scaphoid waist. Among all patients with a scaphoid fracture, type II lunates were more likely than type I lunates to progress to nonunion when treated both operatively and nonoperatively (18.3% vs 4.0%, P = .0042). Lunate facet size was not shown to be a significant risk factor for nonunion among patients with a type II lunate ( P = .4221). Conclusions: Patients with a scaphoid fracture and type II lunate morphology were more likely to progress to nonunion than patients with a type I lunate.

scholarly journals Scaphoid Waist Nonunion in an 8-Year-Old: A Rare Occurrence

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
T. M. Gause ◽  
T. E. Moran ◽  
J. B. Carr ◽  
D. N. Deal
Keyword(s):  
Nonoperative Management ◽  
Pediatric Population ◽  
High Rate ◽  
Carpal Bone ◽  
Radiographic Evaluation ◽  
Injury Patterns ◽  
Adult Type ◽  
Scaphoid Fractures ◽  
Surgical Fixation ◽  
Rate Of Success

Case. Historically, the most common pattern of pediatric scaphoid injury described is at the distal pole, which has a high rate of success with nonoperative management. Injury patterns have evolved as children are more commonly presenting with adult-type fracture patterns. We present the case of a scaphoid waist fracture in an 8-year-old male that resulted in nonunion and required surgical fixation. Conclusion. This case highlights the trend of adult pattern scaphoid fractures in the pediatric population and the utility of magnetic resonance imaging in patients who do not have complete carpal bone ossification at the time of initial radiographic evaluation.

scholarly journals Scaphoid Fracture Patterns—Part Two: Reproducibility and Demographics of a Simplified Scaphoid Fracture Classification

2019 ◽  
Vol 08 (06) ◽  
pp. 446-451
Author(s):  
Tessa Drijkoningen ◽  
Amin Mohamadi ◽  
Wouter F. van Leeuwen ◽  
Yonatan Schwarcz ◽  
David Ring ◽  
...  
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Interobserver Reliability ◽  
Scaphoid Fracture ◽  
Fracture Classification ◽  
Proximal Pole ◽  
Level Of Evidence ◽  
Related Factors ◽  
Scaphoid Fractures ◽  
Fracture Patterns

Abstract Objective To analyze the reproducibility, reliability, and demographics of a simplified anatomical scaphoid fracture classification based on posteroanterior radiographs using a large database of scaphoid fractures. Methods The study consisted of a retrospective review of electronic medical records of 871 consecutive patients. All patients presented between 2003 and 2014 at two centers. Patient- and surgeon-related factors were analyzed. Additionally, interobserver reliability of the Herbert and simplified scaphoid fracture classifications were tested. Results Proximal pole fractures were defined as fractures in which the center of the fracture line was proximal to the distal scapholunate interval (n = 30), waist fractures (n = 802) were defined as fractures involving the scaphocapitate interval, and distal tubercle fractures (n = 39) were defined as fractures involving the scaphotrapeziotrapezoid (STT) interval. The interobserver reliability of the simplified classification was fair (κ = 0.37) as for the Herbert classification (κ = 0.31). The average doubt of the answers of the observers was 2.1 on a scale from 0 to 10 for the simplified classification and 3.6 for the Herbert classification (P < 0.05). Conclusions All complete fractures across the entire scaphoid distal to the scapholunate articulation and proximal to the STT joint can be classified as waist fractures; nonwaist scaphoid fractures are uncommon (6%) and have somewhat different presentations compared to waist fractures. Simplifying the fracture classification slightly improves interobserver reliability, although remaining fair, and significantly reduces doubt. Level of Evidence This is a Level III, prognostic study.

scholarly journals Effect of Screw Length and Geometry on Interfragmentary Compression in a Simulated Proximal Pole Scaphoid Fracture Model

Hand ◽  
2018 ◽  
Vol 15 (3) ◽  
pp. 378-383
Author(s):  
Samik Patel ◽  
Juan M. Giugale ◽  
Richard E. Debski ◽  
John R. Fowler
Keyword(s):  
Analysis Of Variance ◽  
Scaphoid Fracture ◽  
Fracture Site ◽  
Proximal Pole ◽  
Scaphoid Fractures ◽  
Screw Length ◽  
Significant Difference ◽  
Headless Compression Screws ◽  
With Screws ◽  
Interfragmentary Compression

Background: The objective of this study was to determine interfragmentary compression forces based on screw length and geometry for simulated proximal scaphoid fractures. Methods: Sixty-four foam model simulated fractures were stabilized with screws of various length (10 mm, 18 mm, 20 mm, or 24 mm) and geometry (central threadless or fully threaded) across a proximal fracture. Interfragmentary compression was measured at the simulated fracture site upon fixation. An independent sample t test and 1-way analysis of variance were performed to assess differences in interfragmentary compression. Results: Fixation utilizing a 10-mm screw generated significantly less interfragmentary compression than fixation utilizing a 20-mm or 24-mm screw. When accounting for both screw length and geometry, an 18-mm central threadless screw generated greater interfragmentary compression than a 20-mm and 24-mm fully threaded screw; there was no significant difference in compression between an 18-mm and 24-mm central threadless screw. Conclusions: The design of headless compression screws allows for maximal interfragmentary compression at the screw midpoint; we questioned whether a short screw centered on the fracture site resulted in superior compression to a longer, noncentered screw. Our data suggest that centering a small screw (10 mm) along a proximal fracture generates significantly less interfragmentary compression than a longer, noncentered screw. Our results demonstrate that balance between maximizing screw length and centering the screw on the fracture is vital toward maximizing interfragmentary compression for the fixation of proximal third scaphoid fractures.

Surgical Strategy for Scaphoid Nonunion Treatment

2018 ◽  
Vol 23 (04) ◽  
pp. 450-462 ◽  
Author(s):  
Ji Hyun Yeo ◽  
Jin Young Kim
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Surgical Procedures ◽  
Scaphoid Fracture ◽  
Bony Union ◽  
Scaphoid Nonunion ◽  
Carpal Collapse ◽  
Surgical Strategies ◽  
Scaphoid Fractures ◽  
Fracture Nonunion

Scaphoid fracture is the most common carpal fracture. Nonunion rate has been reported around 10 to 15% of scaphoid fractures. Risk factors for scaphoid nonunion are known as location, displacement, poor vascularity, time to treatment etc. The goals of surgical treatment for scaphoid nonunion are to achieve bony union, to correct carpal deformities and also to prevent progressive carpal instability and arthritis. Scaphoid nonunion can cause scaphoid nonunion advanced collapse (SNAC) which is a pattern of progressive degenerative radiocarpal and midcarpal arthritis secondary to posttraumatic pathomechanics of the scapholunate joint. Achieving bony union is essential to prevent carpal collapse or arthritis. To improve bony union, many surgical procedures including various forms of bone grafting have been developed and attempted. However, there is a controversy about which procedure is the most effective. In this review, we provide an overview of surgical treatment methods for scaphoid nonunion and discuss proper surgical strategies for scaphoid nonunion which requires surgical management.

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