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Acute Nondisplaced Scaphoid Fractures Heal Without Surgery

In kids, majority heal without surgery; lower union rate for chronic, displaced, proximal fractures

TUESDAY, July 19 (HealthDay News) -- Most acute, nondisplaced, scaphoid fractures in children and adolescents heal with nonoperative treatment, but those presenting late or with displacement have a lower union rate, according to a study published in the July 6 issue of The Journal of Bone & Joint Surgery.

J. Joseph Gholson, from the Harvard Medical School in Boston, and colleagues characterized contemporary scaphoid fracture patterns and investigated factors influencing time to healing after operative and nonoperative treatment in 312 scaphoid fractures (222 acute, 90 not acute) in children and adolescents with an average age of 14.6 years. Union rates after casting and surgery, and factors influencing both the time to union and union rate were determined in fractures treated from 1995 to 2010.

The investigators identified 248 scaphoid waist, 81 distal pole, and 22 proximal pole fractures. Fractures of the waist or proximal pole were associated with male gender, high-energy injury mechanisms, closed physes, and high body mass index. A 90 percent union rate was achieved for treatment of acute fractures with casting alone, but chronic, displaced, and proximal fractures showed lower union rates. Increased time to union was correlated with fractures that were older, displaced, or proximal, and fractures in patients with osteonecrosis. Fractures treated with surgery had a union rate of 96.5 percent. Longer time to union was correlated with open physes, fracture displacement, proximal fracture, screw type used for surgical fixation, and use of bone graft at the time of surgery.

"While 90 percent of acute nondisplaced fractures heal with nonoperative treatment, three months of cast immobilization or more may be required for more proximal injuries," the authors write. "Almost one-third of pediatric patients with scaphoid fractures will present late with chronic nonunions."

One or more of the study authors disclosed financial ties with a biomedical company.

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