Scaphoid fractures in the pediatric population are uncommon but can usually
be successfully managed with standard immobilization techniques. However,
nonunions of pediatric scaphoid wrist fractures have been reported. We pres
ent the treatment and outcome of 13 pediatric scaphoid fracture nonunions i
n 12 children treated over an 18-year period. The average time elapsed betw
een time of fracture and time of surgery was 16.7 months. Four of the nonun
ions were treated by using the Matti-Russe procedure, and nine were treated
with Herbert screw fixation and iliac crest bone grafting. The average tim
e of follow-up was 6.9 years (range, 2-19 years). All cases went on to clin
ical and radiographic union. There was no statistically significant differe
nce in range of motion or strength between the operative and nonoperative w
rist. Eleven of 12 patients demonstrated an excellent rating based on the M
ayo Modified Wrist score. The length of time for postoperative immobilizati
on in the Herbert screw group was significantly less than that in the Matti
-Russe group. Currently oar standard approach to the treatment of scaphoid
fracture nonunions in the skeletally immature patient is the use of the Her
bert screw and iliac crest bone graft.