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Scaphoid Fracture Associated with Distal Radius Fracture in Children: a Case Report

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Scaphoid Fracture Associated with Distal Radius Fracture in Children: a Case Report View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector Chinese Journal of Traumatology 2009; 12(3):187-188 . 187 . Scaphoid fracture associated with distal radius fracture in children: a case report Hamdi Med Faouzi * he forearm distal bone fracture is the most com- mon fracture in children. Scaphoid frac- Tture is rare because the scaphoid is largely car- tilaginous in children. Some cases associating both distal radius and scaphoid fractures were reported in the literature. Scaphoid fracture often occurs without displacement and can be easily overlooked. We re- ported a case of children wrist injury combining scaphoid fracture with ipsilateral distal fracture. CASE REPORT A 14-year-old boy was seen in the emergency de- Fig. 1. Initial anteroposterior (A) and lateral (B) radiographics of partment of our hospital after sustaining a sport-related the right wrist show a Salter-Harris type II distal radius fracture associated with ipsilateral scaphoid fracture. fall on his outstretched right hand. The patient com- plained of pain and deformity of the wrist. Clinical ex- amination revealed swelling on the dorsum of wrist. The neurovascular status was normal. The roentgenograms of the wrist revealed displaced Salter-Harris type II distal radius fracture associated with an ipsilateral undisplated transverse midscaphoid fracture (Fig.1). Immediate reduction of radius fracture was performed under general anaesthesia by gentle closed manipulation to avoid the displacement of scaphoid fracture. The wrist was immobilized in a long- arm thumb spica cast for 11 weeks. In seven months follow-up, his wrist had a full range of motion without Fig. 2. Anteroposterior (A) and lateral (B) radiographics of the right wrist at the seven months follow-up reveal a union of scaphoid symptoms, and the fracture bone was strengthened in and distal radius fractures. good position (Fig. 2). DISCUSSION Although distal radius fractures have been consid- ered as a common fracture in children, scaphoid frac- tures are rare in the same age1-3 and constitute about 0.4% of all pediatric fractures.1, 4, 5 The combination of DOI: 10.3760/cma.j.issn.1008-1275.2009.03.014 distal radius and ipsilateral scaphoid fractures in chil- Department of Trauma and Orthopaedic Surgery, Hos- dren is remarkably rare and only a few cases have been pital of Fattouma Bourguiba University, Monastir 5000, Tu- 5-10 11 nisia (Faouzi HM) reported. Compson reported three cases of trans- *Corresponding author: Tel: 216-99831236, Fax: 216- carpal injuries associated with an ipsilateral distal ra- 73460678, E-mail: [email protected] dius fracture in children, including two cases of simul- . 188 . Chinese Journal of Traumatology 2009; 12(3):187-188 taneous fracture of the scaphoid and the capitate and In conclusion, if a child presents a distal radius one case of scaphoid and triquetrum fracture. fracture, associated carpal injury should be recognized especially in great external force. The diagnosis of si- In children aged from 5-15 years, the scaphoid is a multaneous displaced distal radius and scaphoid frac- cartilaginous mass surrounding ossific nucleus.9 The tures leads to adequate treatment and a satisfactory thick layer of cartilage surrounding the ossification center clinical result. provides a cushion-effect against fractures, 7,12 so scaphoid fractures in children require a great causal REFERENCES force.8 The scaphoid fracture is the most common car- pal fracture in children with a peak incidence between 1. Christodoulou AG, Colton CL. Scaphoid fractures in the ages of 12-15 years.2 Ligamentous and cartilagi- children. J Pediatr Orthop 1986;6(1):44-57. nous structures of the children’s wrist offer a relative 2. Toh S, Miura H, Arai K, et al. Scaphoid fractures in children: resistance, the impact force being delivered to the dis- problems and treatment. J Pediatr Orthop 2003; 23(2): 216-221. tal radius which is more prone to injury. Unlike scaphoid 3. Huckstadt T, Klitscher D, Weltzien A, et al. Pediatric frac- fractures in adults, paediatric scaphoid fractures involve tures of the carpal scaphoid: a retrospective clinical and radiologi- the distal pole in 59% to 87% of cases, the middle pole cal study. J Pediatr Orthop 2007; 27(4): 447-450. in 12% to 36%, and the proximal pole in 0 to 2% .1, 4 4. Wulff RN, Schmidt TL. Carpal fractures in children. J This type of combined injuries is often reported in chil- Pediatr Orthop 1998;18(4): 462-465. dren over ten years, 6, 8, 9, 10 probably because the 5. Vukov V, Ristic K, Stevanovic M, et al. Simultaneous scaphoid is less cartilaginous and the line of the fractures of the distal end of the radius and the scaphoid bone. J scaphoid fracture is clearly visible. Orthop Trauma 1988;2(2):120-123. 6. Smida M, Nigrou K, Soohun T, et al. Combined fracture of In this case, the association of scaphoid fracture the distal radius and scaphoid in children. Report of 2 cases. Acta and distal radius fracture with posterior displacement Orthop Belg 2003;69(1):79-81. happened from a fall on the palm of an outstretched 7. Hernán-Prado MA, Laplaza FJ. Distal radius epiphysioly- hand with the wrist fixed in dorsiflexion. The diagnosis sis associated with scaphoid fractures in immature patients: re- was confirmed by X-ray and fractures were seen in the port of two cases and review of the literature. J Orthop Trauma same view. If scaphoid fracture did not show up on an 2001;15(1):73-77. X-ray but was still suspected, further immobilization is 8. Tawil HJ, Daumas L, Zerkly B, et al. Scaphoid fracture recommended until MRI or CT scan confirms or rules associated with displaced fracture of the distal end of radius in out this possibility.3 In such associated injury, the im- children. Apropos of a case. Rev Chir Orthop Reparatrice Appar portant particularity is to be careful in the initial Mot 1995;81(8):741-744. management. During the manipulation of the distal ra- 9. Albert MC, Barre PS. A scaphoid fracture associated with a dial fracture, the risk is the displacement of the initially displaced distal radial fracture in a child. Clin Orthop Relat Res nondisplaced scaphoid fracture. 1989;(240):232-235. 10. Greene WB, Anderson WJ. Simultaneous fracture of the Wise reduction by brief vertical traction on the ex- scaphoid and radius in a child. J Pediatr Orthop 1982;2(2):191-194. tremity only lasts for two or three minutes, while the 11. Compson JP. Trans-carpal injuries associated with distal manipulation of distal radius is performed. The traction radial fractures in children: a series of three cases. J Hand Surg Br apparently does not interfere scaphoid healing.9 Immo- 1992;17(3):311-314. bilization in a long-arm thumb cast for three months is 12. Razemon JP. Fractures and pseudarthroses of the carpal necessary for the treatment of such injuries. The scaphoid in children. Rev Chir Orthop Reparatrice Appar Mot scaphoid fractures being sufficiently immobilized in a 1988; 74(8):744-746. cast have a very low non-union rate and scaphoid non- 13. Kay RM, Kuschner SH. Bilateral proximal radial and union in children is reported to be 0 to 3% in large series.13 scaphoid fractures in a child. J Hand Surg Br 1992; 24(2):255-257. This rare complication has been seen in patients who have insufficient treatment as well as in those patients (Received December 2, 2008) whose scaphoid fracture is overlooked. The diagnosis Edited by LIU Jun-lan is made when scaphoid pseudarthrosis is observed..
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