Pediatric scaphoid fractures: predictors of surgery and fracture complications.

OBJECTIVES

To identify clinical and radiographic findings of pediatric scaphoid fractures that predict the need for surgical treatment.

METHODS

A retrospective review of pediatric patients (≤ 18 years) with scaphoid fractures, who underwent radiographic examination and treatment at our tertiary care pediatric hospital, between 2018 and 2024, identified all surgically treated patients. From the remaining conservatively treated patients, age matched comparisons were randomly selected. After randomization and blinded to outcome, skeletal age, fracture characteristics (location, displacement, comminution, articular involvement, perifracture radiodensity, lobulated perifracture resorption, fracture gap), and presence or absence of osteonecrosis were recorded. Findings were compared between surgically treated and conservatively treatd groups to identify predictors of surgery.

RESULTS

Ninety-six children (81 males, 15 females, mean age: 15.0 ± 1.8 years, range: 11.0-17.8) included 48 in the surgery and 48 in the non-surgery groups. Proximal pole fractures (8.3%, 8/96), perifracture radiodensity (26.0%, 25/96), and presence of osteonecrosis (12.5%, 12/96) were uncommon, but were only found among patients in the surgery group. Presence of displacement (81.3% vs. 12.2%, p < 0.01) and more severe displacement (2.2 vs. 0.7 mm, p < 0.01), articular involvement (37.5% vs. 8.3%, p < 0.01), and lobulated perifracture resorption (64.6% vs. 10.4%, p < 0.01) were more common among patients in the surgery than patients in the non-surgery groups. Logistic regression analyses found proximal pole fractures (OR = 6.67, 95% CI: 1.48-16.78, p = 0.04), fracture displacement (OR = 6.30, 95% CI: 1.32-33.87, p < 0.01), and longer delay to initial radiographs (OR = 1.08, 95% CI: 1.04-1.18, p = 0.01) were independent predictors of surgery.

CONCLUSION

Children with scaphoid fractures are more likely to require surgery if radiographic evaluation is delayed, fracture is displaced, or involves the proximal pole.