[Scaphoid fractures in childhood]

This article reviews current knowledge about scaphoid fractures in children and adolescents, including the development of the scaphoid, its injuries and age-specific treatment for acute and late presenting fractures. The following recommendations are based on the literature, although scientific evidence to support treatment strategies is scarce. The diagnosis of scaphoid fractures is often missed on initial X-rays. Therefore all suspected fractures should be treated with a thumb spica cast for 2 weeks, followed by clinical examination and repeat X-ray if symptoms persist. In cases of negative X-ray findings an MRI or alternatively a CT scan are indicated. None or minimally displaced paediatric scaphoid fractures should be treated in a spica cast for at least 7 weeks until union is documented. Unlike in adults, evidence has not been provided for a benefit of routine surgical therapy. Late presenting non-unions that have not yet been treated adequately warrant a trial of conservative therapy, because healing can be expected under prolonged immobilisation. Surgical treatment should be reserved for dislocated fractures, established pseudarthroses that have not united under adequate conservative treatment or for patients to whom prolonged immobilisation does not appear to be acceptable.