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Management Modalities and Outcomes Following Acute Scaphoid Fractures in Children: A Quantitative Review and
Ashkaun Shaterian1, Pauline Joy F Santos1, Christine J Lee1
11 University of California, Irvine, USA.
Insights
Pediatric scaphoid fractures show excellent outcomes with nonoperative treatment, achieving high union rates and minimal wrist pain or motion loss. Surgery is rarely needed for these common childhood wrist injuries.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Traumatology
Background:
- Early evaluation and management of pediatric scaphoid fractures are crucial to prevent complications.
- Current treatment approaches for pediatric fractures exhibit variability among healthcare providers.
- This study aimed to compare clinical outcomes across different treatment modalities for pediatric scaphoid fractures.
Purpose of the Study:
- To compare clinical outcomes of pediatric scaphoid fractures treated with various modalities.
- To evaluate the effectiveness of nonoperative versus operative management.
- To assess union rates, wrist range of motion, and pain levels post-treatment.
Main Methods:
- A comprehensive literature search was conducted on PubMed for studies on acute pediatric scaphoid fractures.
- Included studies were analyzed for treatment protocols and their impact on union rate, wrist range of motion, and pain.
- Quantitative statistical analysis was performed on pooled data from 17 studies involving 812 fractures.
Main Results:
- Nonoperative treatment (cast immobilization) was used in 93.5% of cases, while surgery was employed in 6.5%.
- Excellent bone union rates (96.2%) were observed, with no significant difference between cast immobilization and surgical groups.
- Nonoperative treatment yielded 99.0% normal wrist range of motion and 96.8% pain-free patients at follow-up.
Conclusions:
- Pediatric scaphoid fractures generally have favorable outcomes.
- Nonoperative management is effective, leading to high union rates and minimal residual symptoms.
- Non-surgical treatment is adequate for most acute pediatric scaphoid fractures, suggesting a limited role for surgical intervention.
Background:
Early evaluation and appropriate management of pediatric scaphoid fractures are necessary to avoid complications. To date, current management of pediatric fractures varies among providers. The objective of this study was to compare clinical outcomes following different treatment modalities.
Methods:
A PubMed literature search identified studies involving acute scaphoid fractures in children. Studies were evaluated for treatment provided and their respective effects on union rate, wrist range of motion, and wrist pain. Data were pooled across studies, and quantitative statistical analysis was conducted to compare outcomes.
Results:
Seventeen studies representing 812 acute pediatric scaphoid fractures were included in the current analysis. We found 93.5% of scaphoid fractures were treated with cast immobilization vs 6.5% treated surgically as 13 of 17 authors treated all fractures with immobilization vs 4 of 17 studies who offered surgical intervention. We found pediatric scaphoid fractures had excellent bone union rates (96.2%) with no difference between the cast immobilization and surgery groups ( P value NS). Long- and short-arm thumb spica immobilization protocols were commonly employed; however, we found no difference in the rates of union ( P value NS). At follow-up, 99.0% of patients treated nonoperatively had normal wrist range of motion and 96.8% were pain free.
Conclusions:
Pediatric scaphoid fractures have excellent outcomes. Nonoperative treatment results in a high rate of union with few posttreatment wrist symptoms. Nonsurgical treatment represents an adequate treatment modality in a majority of acute pediatric scaphoid fractures, wherein the role for surgery needs to be better defined.
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