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Incidence, Risk Factors, Management, and Nonunion Rates of Pediatric Scaphoid Fractures: A National Database Study
Katie M Zehner1, Joshua G Sanchez, Julian Smith-Voudouris
1From the Yale Department of Orthopaedics and Rehabilitation (Zehner, Sanchez, Dr. Smith-Voudouris, Dr. Halim, Dr. Grauer), New Haven, CT, and the Yale Department of Plastic and Reconstructive Surgery (Dr. Colen), New Haven, CT.
Insights
Pediatric scaphoid fractures share similarities with adult cases. Key risk factors for nonunion include older age, male sex, obesity, displacement, and proximal location, with many nonunions diagnosed late.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Musculoskeletal research
Background:
- Scaphoid fractures are common in children, often leading to nonunion.
- Limited data exists on pediatric scaphoid fracture incidence, risk factors, and management.
- Understanding these factors is crucial for improving patient outcomes.
Purpose of the Study:
- To characterize the incidence, risk factors, and management of pediatric scaphoid fractures.
- To identify predictors of nonunion in pediatric scaphoid fractures.
- To compare surgical versus non-surgical management of pediatric scaphoid nonunion.
Main Methods:
- Retrospective analysis of the PearlDiver M170 database (2015-2023).
- Inclusion of patients under 18 years with scaphoid fractures.
- Multivariable analyses to identify predictors of nonunion and compare management strategies.
Main Results:
- A total of 26,364 pediatric scaphoid fractures were analyzed.
- Nonunion occurred in 4.2% of cases, associated with older age, male sex, obesity, fracture displacement, and proximal location.
- Most nonunions (73%) were diagnosed within 3 months of initial fracture diagnosis.
Conclusions:
- Pediatric scaphoid fracture characteristics resemble those in adults.
- Late presentation for care is suggested by the timing of nonunion diagnoses.
- Further research into early diagnosis and management is warranted.
Purpose:
Scaphoid fractures are often complicated by nonunion, but incidence, risk factors, and management have not been well-characterized for pediatric patients.
Methods:
Patients aged <18 years with scaphoid fracture were identified in the 2015 to 2023 PearlDiver M170 database. Patient and fracture characteristics, imaging, and surgeries were extracted. Predictive factors for nonunion were characterized with multivariable analyses. Among patients with nonunion, characteristics of those receiving surgical and nonsurgical management were compared with multivariable analyses.
Results:
Of 26,364 pediatric scaphoid fractures, 64.5% were male, with an average age of 13.54 years. Of fractures with displacement and location specified, 22.8% were displaced and distal, middle, and proximal third fractures constituted 45.4%, 45.7%, and 8.9%, respectively. MRI was used for 11.5% and CT for 8.6%. Nonunion occurred in 1102 patients (4.2%). Nonunion was independently associated with clinical characteristics (older age [OR = 1.57 per year], male sex [OR = 2.11], and overweight/obesity [OR = 1.52]), nonclinical characteristics (relative to Northeast, Midwest region OR = 1.45), and fracture characteristics (displacement [OR = 2.45] and position [relative to distal, middle OR = 2.18 and proximal one third location OR = 4.74]) (P < 0.0003 for all). Of nonunions, 73% were diagnosed within 3 months of first fracture diagnosis. Of patients with nonunion, 784 (71.3%) had surgery. Surgery was independently associated with older age (OR = 1.15 per year) and Midwest region (relative to West, OR = 1.96) (P < 0.0063 for all).
Conclusion:
Pediatric scaphoid fracture patient and fracture characteristics roughly mirrored adult populations. The occurrence of most nonunion diagnoses shortly after initial fracture diagnosis suggests that many patients with nonunion presented late to care.
