Early mobilization for suspected scaphoid injuries in children: a feasibility study.

BACKGROUND

The optimal management of children with a suspected scaphoid fracture and normal radiographs is unclear. Traditionally, children have been treated with empiric cast immobilization or with early CT or MRI to avoid missing an occult fracture. An early range of motion (ROM) protocol for these children may be an alternative strategy.

METHODS

We conducted a prospective study to test the feasibility and potential benefits of an early ROM protocol for children with a clinically suspected scaphoid fracture but normal radiographs. Participants were evaluated at 6 weeks and, for those with a confirmed fracture on CT, at 26 weeks after injury.

RESULTS

Of the 39 children (median age 12.2 years; interquartile range 10.6 to 13.8 years), 15 had a scaphoid fracture confirmed on CT. Participant retention rate was 36 of 39 (92%; 95% CI: 80 to 97%) at 6 weeks, and 12 of 15 (80%; 95% CI: 55 to 93%) at 26 weeks. Participants tolerated the protocol without concerns. There were no instances of non-union, avascular necrosis, or other adverse events.

CONCLUSION

An early ROM protocol for children with suspected scaphoid fractures but normal radiographs may reduce overtreatment and dependence on advanced imaging. Further study is feasible and required.

LEVEL OF EVIDENCE: III.