Age-dependent changes in pediatric scaphoid fracture pattern on radiographs

Abstract

Objective

To systematically investigate age-dependent changes in scaphoid fracture prevalence and fracture patterns on radiographs in children under 15 years of age.

Methods and Materials

This retrospective study included children with scaphoid fractures, who underwent radiographic examinations between May 1, 2009, and August 31, 2019. Blinded to outcome, all radiographs were reviewed to determine fracture visibility on initial radiographs; to characterize fracture location (distal corner, distal, mid, and proximal body) and orientation (horizontal oblique, transverse, and vertical oblique); and to identify the presence or absence of gap, displacement, and concomitant fractures. Demographic information and information on weight and height were collected. Mann-Whitney U, Kruskal-Wallis rank sum, chi-square, and post hoc tests were used to investigate associations between age, fracture characteristics, and BMI percentile.

Results

The study included 180 children (134 boys and 46 girls; 12.3 ± 1.4 years) with 59 (33%) distal corner, 42 (23%) distal, 76 (42%) mid, and 3 (2%) proximal body fractures. Younger children were more likely to present with distal corner and distal body fractures while older children with mid and proximal body fractures (p = 0.035). No association was found between age and fracture visibility (p = 0.246), fracture orientation (p = 0.752), presence of gap (p = 0.130), displacement (p = 0.403), or concomitant fractures (p = 0.588). Younger children with scaphoid fractures were more likely to be obese (n = 117; p = 0.038).

Conclusion

Scaphoid fractures of the distal corner and distal body were significantly more common in younger children, who are more likely to be obese.

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References

  1. 1.

    Wulff RN, Schmidt TL. Carpal fractures in children. J Pediatr Orthop. 1998;18(4):462–5.

    CAS  PubMed  Google Scholar 

  2. 2.

    Van Tassel DC, Owens BD, Wolf JM. Incidence estimates and demographics of scaphoid fracture in the U.S. population. J Hand Surg. 2010;35(8):1242–5.

    Article  Google Scholar 

  3. 3.

    Lempesis V, Rosengren BE, Landin L, Tiderius CJ, Karlsson MK. Hand fracture epidemiology and etiology in children-time trends in Malmo, Sweden, during six decades. J Orthop Surg Res. 2019;14(1):213.

    Article  Google Scholar 

  4. 4.

    Sendher R, Ladd AL. The scaphoid. Orthopedic Clin North Am. 2013;44(1):107–20.

    Article  Google Scholar 

  5. 5.

    Ahmed I, Ashton F, Tay WK, Porter D. The pediatric fracture of the scaphoid in patients aged 13 years and under: an epidemiological study. J Pediatr Orthop. 2014;34(2):150–4.

    Article  Google Scholar 

  6. 6.

    Gajdobranski D, Zivanovic D, Mikov A, Slavkovic A, Maric D, Marjanovic Z, et al. Scaphoid fractures in children. Srp Arh Celok Lek. 2014;142(7–8):444–9.

    Article  Google Scholar 

  7. 7.

    Langhoff O, Andersen JL. Consequences of late immobilization of scaphoid fractures. J Hand Surg. 1988;13(1):77–9.

    CAS  Article  Google Scholar 

  8. 8.

    Christodoulou AG, Colton CL. Scaphoid fractures in children. J Pediatr Orthop. 1986;6(1):37–9.

    CAS  Article  Google Scholar 

  9. 9.

    D’Arienzo M. Scaphoid fractures in children. J Hand Surg. 2002;27(5):424–6.

    Article  Google Scholar 

  10. 10.

    Mussbichler H. Injuries of the carpal scaphoid in children. Acta Radiol. 1961;56:361–8.

    CAS  Article  Google Scholar 

  11. 11.

    Vahvanen V, Westerlund M. Fracture of the carpal scaphoid in children. A clinical and roentgenological study of 108 cases. Acta Orthop Scand. 1980;51(6):909–13.

    CAS  Article  Google Scholar 

  12. 12.

    Gholson JJ, Bae DS, Zurakowski D, Waters PM. Scaphoid fractures in children and adolescents: contemporary injury patterns and factors influencing time to union. J Bone Joint Surg Am. 2011;93(13):1210–9.

    Article  Google Scholar 

  13. 13.

    Huckstadt T, Klitscher D, Weltzien A, Muller LP, Rommens PM, Schier F. Pediatric fractures of the carpal scaphoid: a retrospective clinical and radiological study. J Pediatr Orthop. 2007;27(4):447–50.

    Article  Google Scholar 

  14. 14.

    Stuart HC, Pyle SI, Cornoni J, Reed RB. Onsets, completions and spans of ossification in the 29 bonegrowth centers of the hand and wrist. Pediatrics. 1962;29:237–49.

    CAS  PubMed  Google Scholar 

  15. 15.

    Zura R, Kaste SC, Heffernan MJ, Accousti WK, Gargiulo D, Wang Z, et al. Risk factors for nonunion of bone fracture in pediatric patients: an inception cohort study of 237,033 fractures. Medicine. 2018;97(31):e11691.

    Article  Google Scholar 

  16. 16.

    Russe O. Fracture of the carpal navicular. Diagnosis, non-operative treatment, and operative treatment. J Bone Joint Surg Am. 1960;42-a:759–68.

    CAS  Article  Google Scholar 

  17. 17.

    Elhassan BT, Shin AY. Scaphoid fracture in children. Hand Clin. 2006;22(1):31–41.

    Article  Google Scholar 

  18. 18.

    Farr JN, Dimitri P. The impact of fat and obesity on bone microarchitecture and strength in children. Calcif Tissue Int. 2017;100(5):500–13.

    CAS  Article  Google Scholar 

  19. 19.

    Ashley P, Gilbert SR. Obesity in pediatric trauma. Orthopedic Clin North Am. 2018;49(3):335–43.

    Article  Google Scholar 

  20. 20.

    Anz AW, Bushnell BD, Bynum DK, Chloros GD, Wiesler ER. Pediatric scaphoid fractures. J Am Acad Orthopaedic Surg. 2009;17(2):77–87.

    Article  Google Scholar 

  21. 21.

    Ogden CL, Kuczmarski RJ, Flegal KM, Mei Z, Guo S, Wei R, et al. Centers for Disease Control and Prevention 2000 growth charts for the United States: improvements to the 1977 National Center for Health Statistics version. Pediatrics. 2002;109(1):45–60.

    Article  Google Scholar 

  22. 22.

    Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, Flegal KM, Guo SS, Wei R, et al. CDC growth charts: United States. Adv Data. 2000;314:1–27.

    Google Scholar 

  23. 23.

    Evenski AJ, Adamczyk MJ, Steiner RP, Morscher MA, Riley PM. Clinically suspected scaphoid fractures in children. J Pediatr Orthop. 2009;29(4):352–5.

    Article  Google Scholar 

  24. 24.

    Wilson EB, Beattie TF, Wilkinson AG. Epidemiological review and proposed management of ‘scaphoid’ injury in children. Eur J Emergency Med. 2011;18(1):57–61.

    Article  Google Scholar 

  25. 25.

    Pillai A, Jain M. Management of clinical fractures of the scaphoid: results of an audit and literature review. Eur J Emergency Med. 2005;12(2):47–51.

    Article  Google Scholar 

  26. 26.

    Larson B, Light TR, Ogden JA. Fracture and ischemic necrosis of the immature scaphoid. J Hand Surg. 1987;12(1):122–7.

    CAS  Article  Google Scholar 

  27. 27.

    Nguyen JC, Sheehan SE, Davis KW, Gill KG. Sports and the growing musculoskeletal system: sports imaging series. Radiology. 2017;284(1):25–42.

    Article  Google Scholar 

  28. 28.

    Ringler MD, Murthy NS. MR imaging of wrist ligaments. Magn Reson Imaging Clin N Am. 2015;23(3):367–91.

    Article  Google Scholar 

  29. 29.

    Grundy M. Fractures of the carpal scaphoid in children. A series of eight cases. Br J Surg. 1969;56(7):523–4.

    CAS  Article  Google Scholar 

  30. 30.

    Garala K, Taub NA, Dias JJ. The epidemiology of fractures of the scaphoid: impact of age, gender, deprivation and seasonality. Bone Joint J. 2016;98-b(5):654–9.

    CAS  Article  Google Scholar 

  31. 31.

    Faienza MF, D’Amato G, Chiarito M, Colaianni G, Colucci S, Grano M, et al. Mechanisms involved in childhood obesity-related bone fragility. Front Endocrinol. 2019;10:269.

    Article  Google Scholar 

  32. 32.

    Jauregui JJ, Seger EW, Hesham K, Walker SE, Abraham R, Abzug JM. Operative management for pediatric and adolescent scaphoid nonunions: a meta-analysis. J Pediatr Orthop. 2019;39(2):e130–3.

    Article  Google Scholar 

  33. 33.

    Shaterian A, Santos PJF, Lee CJ, Evans GRD, Leis A. Management modalities and outcomes following acute scaphoid fractures in children: a quantitative review and meta-analysis. Hand. 2019;14(3):305–10.

    Article  Google Scholar 

  34. 34.

    Toh S, Miura H, Arai K, Yasumura M, Wada M, Tsubo K. Scaphoid fractures in children: problems and treatment. J Pediatr Orthop. 2003;23(2):216–21.

    PubMed  Google Scholar 

  35. 35.

    Taleisnik J, Kelly PJ. The extraosseous and intraosseous blood supply of the scaphoid bone. J Bone Joint Surg Am. 1966;48(6):1125–37.

    CAS  Article  Google Scholar 

  36. 36.

    Gelberman RH, Menon J. The vascularity of the scaphoid bone. J Hand Surg. 1980;5(5):508–13.

    CAS  Article  Google Scholar 

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Correspondence to Jie C. Nguyen.

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Conflict of interest

JCN and AA receive research grant support from the Radiology Society of North America (RSNA) and the Children’s Cancer Research Fund (CCRF), unrelated to this project.

MKN - None

AG - None

AS - None

ZRM - None

BC - None

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was not required for this retrospective study.

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Nguyen, J.C., Nguyen, M.K., Arkader, A. et al. Age-dependent changes in pediatric scaphoid fracture pattern on radiographs. Skeletal Radiol (2020). https://doi.org/10.1007/s00256-020-03522-9

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Keywords

  • BMI
  • Carpal fracture
  • Children
  • Fracture
  • Radiographs
  • Scaphoid