Operative management of pediatric scaphoid fracture nonunion

Fractures of the scaphoid are uncommon childhood injuries that can usually be successfully managed by standard immobilization techniques. However, scaphoid waist fractures are less frequent in children and may proceed to nonunion. The authors retrospectively reviewed the charts and radiographs of 19 adolescents with 20 scaphoid waist fractures that had required operative intervention for nonunion from January 1975 to December 2000. All cases had undergone a trial of plaster immobilization, averaging 4.2 months, before operative intervention was performed. Operative management resulted in a 100% rate of union. Herbert or AO screw fixation and grafting was performed in 11, 2 had K-wire fixation and bone grafting, 6 had bone grafting and no fixation, and one had screw fixation with no graft. All but three patients were available for telephone interview, with an average follow-up of 6.1 years. One reported having mild pain at rest, 4 had discomfort with heavy activity, and the remaining 12 were pain-free. Only two had restriction of activity because of pain, with the remainder returning to previous levels of function. All but one reported complete satisfaction with the results of their operation. Operative intervention of nonunion of scaphoid waist fractures in children consistently offers successful fusion, with very low rates of nonunion and a high rate of patient satisfaction.