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Epidemiology of scaphoid fractures and non-unions: A systematic review
Peter Jørgsholm1, Daniel Ossowski2, Niels Thomsen2
1Mølholm Private Hospital.
Insights
Scaphoid fractures are common, particularly in young males. This review highlights low evidence quality for scaphoid fracture and non-union epidemiology, especially in children.
Area of Science:
- Orthopedics
- Epidemiology
- Traumatology
Background:
- The scaphoid bone is the most frequently fractured carpal bone in both adults and children.
- Scaphoid fractures and non-unions in pediatric populations are understudied.
- Existing literature reports a broad spectrum of scaphoid fracture incidence rates.
Purpose of the Study:
- To systematically review the existing literature on the epidemiology of scaphoid fractures and non-unions.
- To analyze epidemiological data for both adult and pediatric populations.
- To identify gaps in current research regarding scaphoid injury patterns.
Main Methods:
- A comprehensive electronic literature search was performed.
- Studies published between January 1989 and June 2020 were included.
- The systematic review adhered to PRISMA guidelines, searching major databases like PubMed, Embase, Web of Science, and Cochrane Library.
Main Results:
- 42 studies met the inclusion criteria, with a predominance of retrospective designs.
- Adult scaphoid fractures peak in males aged 20-29, with incidence rates of 107-151/100,000. Females peak earlier (10-19 years) with lower rates (14-46/100,000).
- Fractures predominantly affect the scaphoid waist (60-69%). Non-union risk in adults is 2-5%. Pediatric fractures are more common in boys over 12, with non-unions rare and often linked to missed diagnoses.
Conclusions:
- Significant heterogeneity exists across studies regarding populations, diagnostic criteria, and outcome measures.
- The current body of evidence on the epidemiology of scaphoid fractures and non-unions is considered low.
- Further high-quality research is needed to clarify epidemiological trends and risk factors.
Background:
The scaphoid is the most commonly fractured carpal bone in adults as well as in children. Previous studies have reported a wide range of fracture incidences. Scaphoid fractures and non-unions in children have been sparsely investigated.
Aim:
To perform a systematic review of the current literature on epidemiology of scaphoid fractures and non-unions in adults and children.
Methods:
An electronic literature search was conducted investigating all studies in the literature published between January 1989 and June 23 2020. The systematic review following the PRISMA guidelines and searching in PubMed, Embase, Web of Science and Cochrane library databases was done in June 2020.
Results:
42 studies met our inclusion criteria, 6 studies were prospective, 32 were retrospective and 4 were register studies. The majority of studies relied on conventional radiographs for diagnosis. Scaphoid fractures in adults are predominately found in males with a peak incidence in the age group from 20 to 29 years. Incidence rates in males are reported from 107 to 151/100 000. Females have an earlier peak, in the age group 10 to 19 years, with an incidence from 14 to 46/100 000. Most fractures occur in the middle third of the scaphoid representing 60-69 % of cases. Scaphoid fractures in children are predominately found in boys age 12 and above, while it seldomly occur for children younger than 9 years. In adults the risk for developing a scaphoid non-union is between 2 % and 5 %, the majority affecting males and predominately located at the middle third of the scaphoid. Non-unions among children are rare and mainly due to missed or delayed diagnosis of a fracture in the middle third of the scaphoid.
Conclusion:
This review revealed a substantial heterogeneity among studies concerning study population, diagnosis criterial and outcome measures. Currently, evidence on epidemiology for scaphoid fractures and non-unions are low.
