Pediatric Scaphoid Fracture

pediatric scaphoid fracture xray 

pediatric scaphoid fracture mri
ICD-9 Classification / Treatment
Etiology / Natural History Associated Injuries / DDx
Anatomy Complications
Clinical Evaluation Follow-up Care
Xray / Diagnositc Tests Review References

synonyms:

Pediatric Scaphoid Fracture ICD-9

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Pediatric Scaphoid Fracture Etiology / Epidemiology / Natural History

  •  Generally occur from a fll on an outstretched hand. 
  • Incidence = 0.6/10,000 in children <15yrs old. (Christodoulou AG, J Pediatr Orthop 1986; 6:37.)

Pediatric Scaphoid Fracture Anatomy

  • Proximal pole is completely intraarticular and recieves blood supply from distal pole
  • Superficial palmar branch of radial A volarly & dorsal capsal branch of radial A dorsally(80%)
  • The majority of the blood supply to the scaphoid enters at the dorsal ridge.
  • 65%waist fx, 25%proximal pole, 10%distal pole
  • Enchondral ossification of the scaphoid begins at 5yrs 9 months in males and concludes at 15 yrs 3 months in males. It begins at 4yrs 5 months and concludes at 13 yrs 4 months in females (Stuart HC, Pediatrics 1962;29:237)
  • Bipartite scaphoid occurs rarely and may represent asymptomatic nonunion (Doman AN, J Hand Surg 1990;15Am:869).

Pediatric Scaphoid Fracture Clinical Evaluation

  •  Symptoms often vague
  • Snuffbox tenderness
  • Scaphoid tubercle tenderness
  • Pain with axial loading of 1st metacarpal

Pediatric Scaphoid Fracture Xray / Diagnositc Tests

  •  anteroposterior, lateral, oblique, and scaphoid views.

Pediatric Scaphoid Fracture Classification / Treatment

  • D’Arienzo Classification (D’Arienzo M, J Hand Surg [Br] 2002; 27:424)
  • Type 1: children younger than age 8 years. Rare, fracture line may be purely chondral or may involve part of the ossific nucleus. Require MRI for diagnosis.
  • Type 2: osteochondral fractures;  occur in patients aged 8 to 11 years.
  • Type 3: most common fractures; occur in adolescents aged ≥12 years. Treat as an adult.
  • Anatomic classification: tuberosity, transverse distal pole, avulsion distal pole, waist, and proximal pole

Pediatric Scaphoid Fracture Associated Injuries / Differential Diagnosis

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Pediatric Scaphoid Fracture Complications

Pediatric Scaphoid Fracture Follow-up Care

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Pediatric Scaphoid Fracture Review References

  • Christodoulou AG, Colton CL: Scaphoid fractures in children. J Pediatr Orthop 1986; 6:37-39
  • D’Arienzo M: Scaphoid fractures in children. J Hand Surg [Br] 2002; 27:424-426.