Occult Pediatric Scaphoid Injuries

Abstract

A spherical growth plate circumferentially surrounds the entire ossific centre of each individual carpal bone during development. This growth plate is protective and offers resistance to fracture until sometime in adolescence. Fractures of the carpal scaphoid are rare in children. They are usually incomplete, undisplaced and located in the distal third. Radiographic findings indicative of a scaphoid fracture may be evident 2 to 3 weeks following a wrist injury. Diagnosis of scaphoid injuries in children may be easily missed because of their rarity, their unspecific and discrete clinical symptoms and partly because of difficult radiographic diagnostics. Avascular necrosis and nonunion are exceedingly rare in fresh fractures treated in a scaphoid type forearm-thumb cast. Immobilization is mandatory in cases with a clinical, although nonradiological, diagnosis. The carpal bones lack a periosteal covering. Therefore, a periosteal reaction is not seen at imaging of healing carpal fractures. Sclerosis and bone resorption are more common radiographic findings in the late stage.