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J Am Acad Orthop Surg, Vol 17, No 2, February 2009, 77-87.
© 2009 the American Academy of Orthopaedic Surgeons
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Pediatric Scaphoid Fractures

Adam W. Anz, MD, Brandon D. Bushnell, MD, Donald K. Bynum, MD, George D. Chloros, MD and Ethan R. Wiesler, MD

Dr. Anz is Resident, Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC. Dr. Bushnell is Fellow, Orthopaedic Sports Medicine, Steadman Hawkins Clinic, Denver, CO. Dr. Bynum is Professor of Hand Surgery, Department of Orthopaedic Surgery, University of North Carolina Hospitals, Chapel Hill, NC. Dr. Chloros is Research Fellow, Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center. Dr. Wiesler is Associate Professor, Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center.

None of the following authors or a member of their immediate families has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Anz, Dr. Bushnell, Dr. Bynum, Dr. Chloros, and Dr. Wiesler.

Adam W. Anz, MD, et al

Reprint requests: Dr. Anz, Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Box 1070, Winston-Salem, NC 27157-1070.

Fractures of the immature carpal scaphoid can be challenging to manage. The diagnosis may be missed or delayed because of absent or minimal symptoms. Once diagnosed, most pediatric scaphoid fractures can be successfully treated with cast immobilization. However, this is inadequate for difficult and unique cases. Nonunion may occur as a result of a missed diagnosis or delayed presentation as well as in patients who receive appropriate treatment. Because the natural history in children remains incompletely characterized, the optimal treatment of established pediatric scaphoid nonunions is controversial. Surgical intervention should be considered for displaced fractures in patients who are at or near skeletal maturity or in those in whom nonsurgical treatment has failed.






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