Surgical treatment of pediatric scaphoid fracture nonunions

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.