Epidemiological review and proposed management of 'scaphoid' injury in children.

Background: The epidemiology and optimal management of injury to the paediatric scaphoid (carpal navicular) is unknown.The objective of this study is to evaluate these parameters in the Emergency Department of a tertiary children's hospital.
Methods: A retrospective study of a 12-month period of all children attending a single Paediatric Emergency Department who underwent plain radiography of the scaphoid bone.
Results: One hundred and seventeen children (aged 8-12 years inclusive) were included (0.4% of all attendances). On the initial plain radiographs, 17 children showed definite or suspected fractures. At follow-up, only 12 had confirmed fractures. All these children had fallen onto their outstretched hand. Only one patient with normal plain radiographs at presentation was subsequently diagnosed with a scaphoid fracture. All healed without evidence of avascular necrosis.
Conclusion: Pain in the anatomical snuff box is a poor indicator of bone injury to the scaphoid of any sort. Scaphoid fracture is a rare injury in childhood and from this study, it is extremely unlikely to occur under the age of 9 years.The actual bone pathology of an injured paediatric scaphoid may not be clear, but these children have significant pain and tenderness. Further studies are warranted to improve the diagnostic process and the management of paediatric scaphoid injury.