gms | German Medical Science

58. Kongress der Deutschen Gesellschaft für Handchirurgie

Deutsche Gesellschaft für Handchirurgie

12. - 14.10.2017, München

Scaphoid Nonunions in the Skeletally Immature: Case series and evidence-based management

Meeting Abstract

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  • corresponding author presenting/speaker Kerstin Oestreich - Children's Hand and Upper Limb Service, Department of Plastic Surgery Birmingham Children's Hospital, Birmingham, United Kingdom
  • Servet Elcin Alpat - University of Alberta, Edmonton, Canada
  • Tommy R. Lindau - Pulvertaft Hand Unit, Royal Derby Hospital, Derby, Derby, United Kingdom

Deutsche Gesellschaft für Handchirurgie. 58. Kongress der Deutschen Gesellschaft für Handchirurgie. München, 12.-14.10.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. Doc17dgh088

doi: 10.3205/17dgh088, urn:nbn:de:0183-17dgh0880

Published: October 10, 2017

© 2017 Oestreich et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objectives: Carpal bones are rarely fractured in children. Despite low incidence, scaphoid is the most commonly fractured carpus and represents 0.3% of all paediatric fractures. Once promptly treated, vast majority of scaphoid fractures heal. However, one may still encounter scaphoid nonunions(SN). The authors aim to present their experience on paediatric SNs together with the review of recent literature.

Method: Patients were treated by two hand surgeons,receiving different treatments according to the healing capacity of the nonunion and vascularization.

Between 2008–2016,five patients were diagnosed with SNs. Patients were followed up with wrist X-rays,MRI and CT scans accordingly.

Results: The age range was 11–15 years with median of 12,6.The male to female ratio was 4:1.

Three patients were diagnosed with missed SNs which were localized at the waist.

One patient needed iliac bone grafting and Herbert screw fixation. He went back to normal activities within 6 months, being completely asymptomatic.

The second patient is awaiting surgery with the same technique.

The third patient was treated conservatively demonstrating good cortical bridging, bone stock and vascularity.

Despite early diagnosis, two patients developed SNs. First patient was diagnosed with waist fracture; immobilized for 6 weeks. He developed undisplaced SN at 16th week. Being clinically normal, control MRI confirmed persistent nonunion. Subsequent radiographs revealed normal ossification with persistent bony nonunion without signs of degeneration.The patient remains asymptomatic.

The second patient had proximal pole fracture with lucency at fracture site. He was suspected to have pathological fracture from an enchondroma who eventually ended up in DISI and SN.He received DISI correction, distal radius bone grafting, TwinFix screw fixation with dorsal approach.

Conclusion: The nonunion rate in literature ranges between 0.8 and 1.5%, representing neglected injuries. The published treatments vary from casting to open reduction with bone grafting and Kirschner wire or screw fixation. Excellent outcomes have been reported with nonsurgical managements as well as surgical approaches with few complications.

Overall, we recommend a period of nonoperative approach with undisplaced SNs unless one observes displaced,persistent nonunions. When surgery is required,we do advise to utilise familiar surgical techniques for the treatment of SNs in adults as all methods have been reported to be successful in limited case reports.Our findings support this management.