Scaphoid nonunions in children and adolescents: surgical treatment with bone grafting and internal fixation.

Abstract

Scaphoid nonunions are extremely uncommon injuries in children. On account of the rarity of the injury, there is no agreement about the standard method of treatment. The purpose of this study was to evaluate the clinical and radiologic outcomes after surgical treatment with bone grafting and internal fixation. We retrospectively analyzed 23 patients aged 18 years or less with unstable scaphoid nonunions who underwent bone grafting and internal fixation. Mean age at the time of surgery was 15.1 years and the average duration of clinical follow-up was 5.2 years (range, 1-17 y). Scaphoid Outcome Score was used to assess clinical results. Radiographic evaluation included preoperative and postoperative scapholunate angle, radiolunate angle, and the scaphoid length. Twenty-two of 23 patients (95.6%) achieved clinical and radiographic union in an average time of 10.3 weeks (8-14 wk). One patient required a second bone grafting to heal. Functional outcomes were excellent in 17 cases, and good in 6 cases. The average scapholunate angle was 53.4+/-5 degrees preoperatively and 51.2+/-7 degrees at the final follow-up. The mean radiolunate angle was 7.4+/-5 degrees preoperatively and 4.9+/-3.9 degrees at the final follow-up. Scaphoid length increased from 21.9+/-1.1 to 23.1+/-1.2 mm (P>0.05). There were no perioperative complications. Clinical and radiologic outcomes are encouraging to recommend this method for scaphoid nonunions in children and adolescents. Case series (level of evidence, IV).