Carpal fractures

Abstract

Fractures of the pediatric carpus are relatively rare. The literature describing them consists mostly of case reports and case series, with the majority of reports devoted to fractures of the scaphoid in this population. A fair number of series available report on the treatment of scaphoid nonunions in the pediatric population, which is also a relatively rare entity. Due to the ossification of the pediatric carpus, throughout childhood and early adolescence, a large portion of the pediatric carpus is cartilaginous, which can make radiographic evaluation difficult. Therefore, a high index of clinical suspicion for a carpal fracture in the pediatric population must be present on the part of the examining physician when radiographs of the immature carpus are negative for fracture, but the physical examination is suggestive of injury being present. Immobilization and careful follow-up with observation and repeat radiographs in 2–3 weeks are warranted to aid in diagnosis. Fractures of the scaphoid are the most commonly seen pediatric carpal fracture. This is followed in incidence by fractures of the capitate, with fractures of the remaining carpal bones quite rare in isolation. These other carpal fractures are usually nondisplaced and require only routine immobilization to obtain successful healing. However, in the case of a displaced carpal fracture, open reduction and internal fixation is warranted. Most often, temporary Kirschner wire fixation is sufficient. Failure to diagnose or initiate appropriate treatment promptly in the case of a scaphoid fracture can result in nonunion. However, even with full patient compliance, accurate and early diagnosis, and appropriate treatment, nonunion can occur. Fortunately, nonunion of the scaphoid is rare in the pediatric and adolescent population. Treatment of scaphoid nonunions surgically with nonvascularized bone graft from the distal radius yields union rates approaching 100 % with few complications or long-term problems.