Inferior Pole Scaphoid Nonunion in a 12-Year-Old Boy: Lessons on Compliance, Follow-Up, and Surgical Salvage-A Case...

Background and Clinical Significance: Scaphoid fractures and nonunion are uncommon in skeletally immature patients. Pediatric nonunion most often follows a missed or delayed diagnosis or failure of conservative treatment. Inferior-pole nonunion is particularly uncommon, and evidence guiding graft selection in children is limited. We report a case in which preoperative and intraoperative assessment of fragment viability supported the use of a non-vascularized graft. Case presentation: A 12-year-old boy sustained a right inferior-pole scaphoid fracture after falling onto an outstretched hand. The fracture was missed at the initial emergency-department visit. Thumb-spica immobilization was subsequently prescribed, but the patient repeatedly removed the cast, missed appointments, and was lost to follow-up. At referral six months after injury, radiographs and multiplanar CT demonstrated established inferior-pole nonunion. MRI showed preserved marrow fat signal in both fragments without osteonecrosis. Open reduction and internal fixation were performed through a dorsal approach using a 2.4 mm headless compression screw and approximately 1 cc of cancellous iliac-crest autograft. Intraoperatively, both fragments appeared viable, without cystic or sclerotic change. At two months, the patient was pain-free and radiographs showed progressing union. The Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score improved from 25 preoperatively to 10 at two months. CT at six months confirmed complete osseous union, with a QuickDASH score of 0. At 1.5 years, he remained pain-free, had full flexion with a 5° terminal extension lag, and had returned to table tennis without functional limitation. Conclusions: In this inferior-pole scaphoid nonunion, open reduction and internal fixation with iliac-crest cancellous autograft achieved CT-confirmed union and sustained functional recovery. MRI and intraoperative confirmation of viable bone supported selection of a non-vascularized graft. At 1.5 years, the patient was pain-free, had returned to sport without functional limitation, and had a QuickDASH score of 0.