Tataria Rachana, Ting Jeannette, Jester Andrea, Lindau Tommy R, Oestreich Kerstin
Hand and Upper Limb Service, Department of Plastic Surgery, Birmingham Women and Children's Hospital, Birmingham, United Kingdom.
Department of Plastic & Reconstructive Surgery, Monash Children's Hospital, Clayton, Victoria, Australia.
J Wrist Surg. 2020 Dec;9(6):458-464. doi: 10.1055/s-0040-1713800. Epub 2020 Jul 15.
Scaphoid fractures are relatively uncommon in children, especially below the age of 10 due to the ossification of the scaphoid bone, which starts around 4 to 6 years of age and continues until 13 to 15 years of age, where pediatric scaphoid fractures peak. This makes the diagnoses challenging in this age group. The primary aim of this study was to analyze prospectively collected data in managing scaphoid fractures. All cases in children up to the age of 10 years, treated in a tertiary pediatric hand and upper limb from January 2014 to June 2018 were included. Parameters studied were patient demographics, clinical presentation, mechanism of injury, investigations, type of fracture, associated injuries, treatment offered, outcomes and complications. The secondary aim was to review the literature due to the limited knowledge about these fractures in these low age groups. A total of 23 patients with documented scaphoid fractures in children up to the age of 10 years were found. Final diagnosis in all these patients was done with magnetic resonance imaging (MRI). The mean age was 9.8 years, with female preponderance. Scaphoid waist was the most common location. Five patients had associated fractures of the capitate and one patient had associated second metacarpal base fracture. All patients were managed nonoperatively. The average time of immobilization was 6.6 weeks (range: 4-10 weeks). A majority of patients had minor symptoms after the fracture, most likely due to the immobilization time. Scaphoid fractures are rare in the pediatric population up to the age of 10. MRI is most often needed to confirm diagnosis. Nonoperative management of most scaphoid fractures in this age group is safe and feasible with no significant long-term morbidity. Surgical management of scaphoid fractures might be required in very selected cases. This is a Level IV study.
舟状骨骨折在儿童中相对少见，尤其是10岁以下儿童，这是因为舟状骨在4至6岁左右开始骨化，并持续至13至15岁，此年龄段小儿舟状骨骨折最为常见。这使得该年龄组的诊断具有挑战性。 本研究的主要目的是分析前瞻性收集的舟状骨骨折治疗数据。纳入了2014年1月至2018年6月在一家三级儿科手部及上肢中心接受治疗的所有10岁以下儿童病例。研究参数包括患者人口统计学资料、临床表现、损伤机制、检查、骨折类型、合并损伤、治疗方式、结果及并发症。次要目的是鉴于对这些低年龄组骨折的了解有限，对相关文献进行综述。 共发现23例10岁以下儿童有舟状骨骨折记录。所有这些患者均通过磁共振成像（MRI）进行最终诊断。平均年龄为9.8岁，女性居多。舟状骨腰部是最常见的骨折部位。5例患者合并头状骨骨折，1例患者合并第二掌骨基底骨折。所有患者均采用非手术治疗。平均固定时间为6.6周（范围：4 - 10周）。大多数患者骨折后有轻微症状，很可能与固定时间有关。 10岁以下小儿人群中舟状骨骨折罕见。通常需要MRI来确诊。该年龄组大多数舟状骨骨折采用非手术治疗安全可行，无明显长期并发症。在极少数情况下可能需要对舟状骨骨折进行手术治疗。 这是一项四级研究。
