Backgrounds. The prevalence of pediatric fractures of the carpal bones of the wrist is 0.2% per 10,000 children, however, scaphoid bone fractures are predominant among them nearly 65%. Scaphoid fractures hardly ever happen with young children, below 10 years old because the bone is mainly cartilage until 13 - 15 years [1]. The most common complication of scaphoid bone fracture is non-union. The treatment management of patients with nonunion of scaphoid fracture must consider special blood supply of the bone, long-time immobilization of the wrist, and high risk of aseptic osteonecrosis, bone grafting is essential to restore normal anatomy and reduce pain.
Aim of study: enhance surgical management of nonunion of the pediatric scaphoid fractures.
Materials and Methods. Eight cases of children (age 14-17 years) with pediatric scaphoid fracture non-union who were treated at Regional Child Clinical Hospital between 2014-2022 years. All of them had sports injuries more than one year ago, and no one claimed medical care. All diagnoses were proved by plane x-ray and MRI examinations. According to Herbert - Fisher classification 1 patient had Type C, 3 – Type D1 and 4 Type - D2 [2]. Surgical management – open resection of edges sclerotic changed fragments of the scaphoid bone with bone grafting by modified Matti-Russe procedure [3] and Herbert screw osteosynthesis [4]. After treatment management consisted of wrist plaster cast in the physiological position within 3 months and orthesis wearing next 2-3 months. Follow-up treatment consisted of hydrokinesiotherapy, massage, therapeutic exercises to restore passive and then active ROM by wrist and hand (stretchening, joint mobilization), physical procedures like UHF and occupational therapy [5]. Outcomes were adjudicated by clinical signs, active and passive ROMs of the wrist and forearm, PRWE (Patient-Rated Wrist Evaluation) scale [6] and control x-ray. Statistical analysis was performed on MS Exel software. Normality was verified using the Shapiro-Wilk test and graphic test. Non-parametric the Mann-Whitney U test for dependent groups was used.
Results and Discution. The complete bone fracture healing and bone graft rebuilt was achieved after 5 months according to the x-ray exam. Clinical evaluation was detected as satisfied if absence of clinical findings (spontaneous pain at day and/or night, pain at wrist motion, pain at compression of snuffbox). Therefore, all patients were estimated as accomplish a good result. Complete active and passive ROMs of the wrist and forearm were renewed two months after surgery for all patients. Pain and disability in activities of daily living according to PRWE scale before surgery was 71,511,99 and 5 months after 44,7515,35 (p= 0,0027). According to pain subscale most patients have residual mild pain when lifting heavy objects or play some sport even after complete healing of the scaphoid bone non-union. Otherwise function subscale proved almost complete recovery in section A (special activities) and some issues with section B (usual activities).
Conclusions: Our study confirms that modified Matti-Russe surgical procedure and proper follow-up rehabilitation treatment of scaphoid fracture non-union help to reach complete bone fracture healing and restore wrist function 5-6 months after surgery.
References:
1. Tataria R, Ting J, Jester A, Lindau TR, Oestreich K. Scaphoid Fractures below the Age of 10: Case Series and Review of the Literature. J Wrist Surg. 2020 Dec;9(6):458-464. doi: 10.1055/s-0040-1713800. Epub 2020 Jul 15. PMID: 33282529; PMCID: PMC7708027.
2. Charles M. Court-Brown, James D. Heckman, Margaret M. McQueen et al. Rockwood and Green's Fractures in Adults. (2015) ISBN: 9781451175318
3. Lee S. Fractures of carpal bones. In: Wolfe S., Pederson W., Kozin S.H.C.M., editors. Green's Operative Hand Surgery. seventh ed. Elsevier; Philadelphia: 2016. p. 2091.
4. Erhart, J., Unger, E., Trulson, I. et al. Pull-out forces of headless compression screws in variations of synthetic bone models imitating different types of scaphoid fractures in good bone quality. J Mater Sci: Mater Med 31, 92 (2020). https://doi.org/10.1007/s10856-020-06445-y
5. Goffin JS, Liao Q, Robertson GA. Return to sport following scaphoid fractures: A systematic review and meta-analysis. World J Orthop. 2019 Feb 18;10(2):101-114.
6. Angst F, John M, Goldhahn J, et al. Comprehensive assessment of clinical outcome and quality of life after resection interposition arthroplasty of the thumb saddle joint. Arthritis Rheum. 2005;53(2):205-213. doi:10.1002/art.21085
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