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Spontaneous Healing Of A Pediatric Scaphoid Proximal Pole Fracture Nonunion

Rupani, N. 2018Other/Unknown

Rupani, N., Riley, N., & McNab, I. (2018). Spontaneous Healing of a Pediatric Scaphoid Proximal Pole Fracture Nonunion. Journal of wrist surgery, 7(1), 81–83. https://doi.org/10.1055/s-0037-1602799

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Abstract

Background  Scaphoid fractures in the pediatric population are rare. The majority of nondisplaced fractures tend to unite; however, there is an increased risk of nonunion in proximal pole fractures. Limited evidence exists in their outcomes, owing to the scarcity of the fracture pattern. Case Description  A 13-year-old boy who presented late after developing a traumatic proximal pole scaphoid fracture developed nonunion. He was treated conservatively owing to it being asymptomatic and developed union at 18 months. Literature Review  No previous case of proximal pole pediatric scaphoid fractures with established nonunion that has developed union with conservative management has been described. Clinical Relevance  The authors highlight a unique case of an established proximal pole scaphoid nonunion in a child progressing to union with nonoperative intervention. Owing to its rarity and difficulty in obtaining research, we recommend consideration of nonoperative management of asymptomatic nondisplaced proximal pole fractures in children.

Case Details

Disease Location

Scaphoid

Personal Characteristics

3-year-old boy

Clinical Characteristics

Sustained a forced flexion injury of his wrist with axial loading when he was trapped between the ground and an opposing larger rugby player during a tackle. He presented 6 weeks after the trauma. Radiographs demonstrated a proximal pole fracture of the right scaphoid. He was treated in a scaphoid cast for 6 weeks. 6 weeks after he was treated with a cast, radiographs demonstrated no progression to union. He was managed with a further 6 weeks of cast immobilization. At 18 weeks postinjury, he was asymptomatic, but radiographs demonstrated a persistent fracture line.

Remission Characteristics

18 months later, a union had been achieved

Treatment & Mechanisms

Proposed Remission Mechanisms

Cast immobilization