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Epidemiological review and proposed management of 'scaphoid' injury in children
Emma-Beth Wilson1, Tom F Beattie, A Graham Wilkinson
1aEmergency Department bRadiology department, Royal Hospital for Sick Children, Sciennes Road, Edinburgh, UK.
Insights
Pediatric scaphoid fractures are rare, particularly in children under 9. Pain in the anatomical snuff box is an unreliable indicator of scaphoid injury in children.
Area of Science:
- Pediatric Orthopedics
- Pediatric Emergency Medicine
- Radiology
Background:
- Epidemiology and optimal management of pediatric scaphoid (carpal navicular) injuries remain unclear.
- Tertiary children's hospital emergency department data is needed to understand these injuries.
Purpose of the Study:
- To evaluate the epidemiology and management of pediatric scaphoid injuries.
- To assess diagnostic parameters in a pediatric emergency department setting.
Main Methods:
- Retrospective study over 12 months.
- Included children undergoing scaphoid bone radiography in a single Pediatric Emergency Department.
- Analyzed plain radiographs and follow-up data.
Main Results:
- 117 children (8-12 years) included; 0.4% of attendances.
- Initial radiographs showed 17 suspected fractures; 12 confirmed at follow-up.
- Pain in the anatomical snuff box was a poor indicator; injury rare under 9 years.
Conclusions:
- Scaphoid fractures are uncommon in children, especially those under 9.
- Anatomical snuff box tenderness is not a reliable sign of scaphoid injury.
- Further research is needed to enhance diagnostic accuracy and management strategies for pediatric scaphoid injuries.
Background:
The epidemiology and optimal management of injury to the paediatric scaphoid (carpal navicular) is unknown.The objective of this study is to evaluate these parameters in the Emergency Department of a tertiary children's hospital.
Methods:
A retrospective study of a 12-month period of all children attending a single Paediatric Emergency Department who underwent plain radiography of the scaphoid bone.
Results:
One hundred and seventeen children (aged 8-12 years inclusive) were included (0.4% of all attendances). On the initial plain radiographs, 17 children showed definite or suspected fractures. At follow-up, only 12 had confirmed fractures. All these children had fallen onto their outstretched hand. Only one patient with normal plain radiographs at presentation was subsequently diagnosed with a scaphoid fracture. All healed without evidence of avascular necrosis.
Conclusion:
Pain in the anatomical snuff box is a poor indicator of bone injury to the scaphoid of any sort. Scaphoid fracture is a rare injury in childhood and from this study, it is extremely unlikely to occur under the age of 9 years.The actual bone pathology of an injured paediatric scaphoid may not be clear, but these children have significant pain and tenderness. Further studies are warranted to improve the diagnostic process and the management of paediatric scaphoid injury.
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