Incidence, Risk Factors, Management, and Nonunion Rates of Pediatric Scaphoid Fractures: A National Database Study.

Abstract

Scaphoid fractures are often complicated by nonunion, but incidence, risk factors, and management have not been well-characterized for pediatric patients. Patients aged <18 years with scaphoid fracture were identified in the 2015 to 2023 PearlDiver M170 database. Patient and fracture characteristics, imaging, and surgeries were extracted. Predictive factors for nonunion were characterized with multivariable analyses. Among patients with nonunion, characteristics of those receiving surgical and nonsurgical management were compared with multivariable analyses. Of 26,364 pediatric scaphoid fractures, 64.5% were male, with an average age of 13.54 years. Of fractures with displacement and location specified, 22.8% were displaced and distal, middle, and proximal third fractures constituted 45.4%, 45.7%, and 8.9%, respectively. MRI was used for 11.5% and CT for 8.6%. Nonunion occurred in 1102 patients (4.2%). Nonunion was independently associated with clinical characteristics (older age [OR = 1.57 per year], male sex [OR = 2.11], and overweight/obesity [OR = 1.52]), nonclinical characteristics (relative to Northeast, Midwest region OR = 1.45), and fracture characteristics (displacement [OR = 2.45] and position [relative to distal, middle OR = 2.18 and proximal one third location OR = 4.74]) (P < 0.0003 for all). Of nonunions, 73% were diagnosed within 3 months of first fracture diagnosis. Of patients with nonunion, 784 (71.3%) had surgery. Surgery was independently associated with older age (OR = 1.15 per year) and Midwest region (relative to West, OR = 1.96) (P < 0.0063 for all). Pediatric scaphoid fracture patient and fracture characteristics roughly mirrored adult populations. The occurrence of most nonunion diagnoses shortly after initial fracture diagnosis suggests that many patients with nonunion presented late to care.