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Predictors of True Scaphoid Fractures in Children
Daniel Milad1, Aneesh Karir2, Kevin Smit3
1Department of Ophthalmology, University of Montreal, Montreal, QC, Canada.
Insights
Older boys are more likely to have true scaphoid fractures, a common wrist injury in children. This finding helps guide diagnosis and treatment for suspected scaphoid fractures.
Area of Science:
- Pediatric Orthopedics
- Pediatric Traumatology
- Radiology
Background:
- The scaphoid bone is the most frequently fractured carpal bone in children.
- Diagnosing true scaphoid fractures in children is challenging due to potential lack of initial radiographic evidence.
- Clinical suspicion alone may lead to immobilization, necessitating better diagnostic predictors.
Purpose of the Study:
- To identify predictors of true scaphoid fractures in pediatric patients.
- To aid in clinical decision-making for managing suspected scaphoid fractures.
- To improve diagnostic accuracy for pediatric wrist injuries.
Main Methods:
- Retrospective cohort study at a tertiary pediatric hospital.
- Comparison of demographic and clinical characteristics between true scaphoid fracture and clinical suspicion groups.
- Univariate and multivariate statistical analyses to determine fracture predictors.
Main Results:
- Older age (median 14.2 years) and male sex were significantly associated with true scaphoid fractures.
- Older age (OR 1.25) and male sex (OR 2.93) were independent predictors of true scaphoid fractures.
- True scaphoid fractures were confirmed in 57 of 130 pediatric patients.
Conclusions:
- Older male children face an elevated risk for true scaphoid fractures.
- These findings can inform decisions regarding further imaging and treatment strategies.
- Improved identification of pediatric scaphoid fractures can optimize patient management.
Background:
The scaphoid is the most commonly fractured carpal bone in children. True scaphoid fractures have proven to be difficult to diagnose, as they may not be apparent on initial imaging. Children with clinical suspicion of a scaphoid fracture may be treated with continued immobilization, even in the absence of radiographic evidence of a fracture. The purpose of this study is to identify predictors of true scaphoid fractures in children to help guide management.
Methods:
This study is a retrospective cohort study of children presenting to a tertiary pediatric hospital with hand or wrist injuries. Patients were grouped based on the presence of a true scaphoid fractures (confirmed on imaging) or those with clinical suspicion of a scaphoid fracture alone (no radiographic evidence of fracture). Demographic and clinical characteristics were compared with univariate and multivariate statistics to identify fracture predictors.
Results:
One hundred and thirty patients were included in the study: 57 in the true scaphoid fracture group and 73 in the clinical scaphoid fracture group. Patients with a true scaphoid fracture were older than those with a clinical scaphoid fracture (median age [interquartile range], 14.2 [13.0-15.4] vs 12.9 [11.9-14.4], P = .01). Men were more likely to sustain a true scaphoid fracture (65.0% vs 35.0%, P = .01). Older age and male sex were shown to be independent predictors of true scaphoid fractures (odds ratio [95% confidence interval], 1.25 [1.03-1.50] and 2.93 [1.39-6.17], respectively).
Conclusions:
In the pediatric population, older age and male children may be at increased risk of true scaphoid fractures. This may help guide decisions surrounding further imaging and treatment.
