Fractures and nonunions of the carpal scaphoid in children

Fractures of the carpal scaphoid in children show some quite remarkable differences with respect to fractures of the carpal scaphoid in adults. A review of the literature shows that fractures in children are more often located in the distal third, are more often incomplete and are usually not displaced. Our experience with 23 fresh fractures of the carpal scaphoid in children confirm these findings of the literature. Nonunion of the carpal scaphoid is exceedingly rare in children. When reviewing the literature we could only find 25 published cases of nonunion of the carpal scaphoid in children. In most articles describing carpal scaphoid nonunion in children, bone grafting is recommended as the treatment of choice. We report two children with a nonunion of the carpal scaphoid treated succesfully by cast immobilization. Therefore, we propose that a child with a nonunion of the carpal scaphoid bone that has never been immobilized previously should be treated by cast immobilization. Surgery should be considered only if there is no indication of healing after 3 months of immobilization.