Clinically Significant Treatment Delay in Pediatric Scaphoid Fractures.
Document Type
Article
Publication Date
2-2024
Identifier
DOI: 10.1016/j.jhsa.2023.10.020
Abstract
PURPOSE: Pediatric scaphoid fractures present to treatment in a delayed manner 8% to 29% of the time. The indications for cast immobilization in this population are not clear. The definition of a clinically important treatment delay is based only on anecdotal reports. Successful treatment with a cast may be more desirable than surgical intervention. However, it remains unclear what clinical and radiographic factors may predict success with casting.
METHODS: A retrospective analysis of all scaphoid fractures treated at a single pediatric hospital was performed to identify fracture characteristics, the presence of cystic change, treatment method, and healing rate. A cut-point analysis was performed to determine the number of days of treatment delay, predictive of casting failure. Kaplan-Meier assessments were performed to determine the differences in time in cast. Characteristics of the delayed group were described and stratified by treatment success or failure.
RESULTS: After review, 254 patients met the inclusion criteria. Cut-point analysis determined that a presentation delay of ≥21 days was associated with failure to unite with casting. The median time in the cast for the acute and delayed groups was not significantly different. The casting union rate of delayed fractures was less than acute fractures (75.0% vs 97.0%).
CONCLUSIONS: Delayed presentation of scaphoid fractures 21 days or more after injury predicts a greater risk of casting failure; however, the union rate remains high with comparable time in cast. Cast immobilization for scaphoid fractures presenting 21 days or more after injury is a reasonable option.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognosis IV.
Journal Title
J Hand Surg Am
Volume
49
Issue
2
First Page
108
Last Page
113
MeSH Keywords
Humans; Child; Fractures, Bone; Retrospective Studies; Treatment Delay; Scaphoid Bone; Wrist Injuries; Hand Injuries; Casts, Surgical
Keywords
Casting; fracture; nonunion; pediatrics; scaphoid
Recommended Citation
Lackey JT, Seiler PL, Lee BR, Sinclair MK. Clinically Significant Treatment Delay in Pediatric Scaphoid Fractures. J Hand Surg Am. 2024;49(2):108-113. doi:10.1016/j.jhsa.2023.10.020
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