Pediatric Scaphoid Fracture ICD-9
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
Pediatric Scaphoid Fracture Complications
Pediatric Scaphoid Fracture Follow-up Care
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.