Our Summary

This research looked at how children with suspected wrist fractures, specifically scaphoid fractures, were treated and what the outcomes were. A scaphoid fracture is hard to identify because it often doesn’t show up on initial X-rays.

The study looked at medical records from a children’s hospital over a two-year period. It included 91 patients, aged between 7.8 and 17.7 years, who showed signs of a scaphoid fracture, but had two X-rays taken 7-14 days apart that didn’t show a fracture.

The findings showed that 16 of these patients (around 17%) had more advanced imaging - such as a CT scan or MRI - done, on average about 10 weeks after their injury. Of these, 5 patients (about 5%) were found to have a scaphoid fracture, on average about 4.5 weeks after their injury. Six other patients were found to have different types of wrist fractures.

The study also found that the surgeon and the radiologist disagreed on the interpretation of the X-rays about 30% of the time. However, none of the patients required surgery.

The researchers concluded that while the hospital had a consistent approach to suspected scaphoid fractures (almost all patients had their wrist immobilized and fewer than 20% had advanced imaging), the findings suggest that there is room for improvement, particularly in terms of the use of advanced imaging and the interpretation of X-rays. This could be the focus of future research.

FAQs

  1. What is a scaphoid fracture and why is it difficult to identify?
  2. What were the main findings of the study on children with suspected scaphoid fractures?
  3. What improvements did the researchers suggest for the approach to diagnosing scaphoid fractures in children?

Doctor’s Tip

A doctor might tell a patient undergoing scaphoid fracture surgery to follow their post-operative care instructions carefully, including keeping the wrist immobilized as directed, attending follow-up appointments, and participating in physical therapy to aid in the recovery process. It is important to communicate any concerns or changes in symptoms to the medical team to ensure proper healing and optimal outcomes.

Suitable For

In general, patients who are recommended scaphoid fracture surgery are those who have a confirmed scaphoid fracture that is not healing properly with conservative treatment methods such as immobilization or casting. Surgery may be recommended if the fracture is displaced, unstable, or at risk of non-union (where the bones do not heal together properly). Additionally, surgery may be considered for patients who have delayed diagnosis of a scaphoid fracture or for those who have complications such as avascular necrosis (loss of blood supply to the bone). Ultimately, the decision to proceed with scaphoid fracture surgery is made on a case-by-case basis by a healthcare provider based on the individual patient’s specific circumstances and needs.

Timeline

Before scaphoid fracture surgery:

  • Patient experiences wrist pain and swelling after injury
  • Initial X-rays may not show a fracture
  • Patient may undergo a period of immobilization with a splint or cast
  • Patient may undergo further imaging, such as a CT scan or MRI, to confirm the presence of a scaphoid fracture
  • Surgeon and radiologist may disagree on interpretation of X-rays
  • Patient may wait several weeks before a definitive diagnosis is made

After scaphoid fracture surgery:

  • Patient undergoes surgery to repair the scaphoid fracture, which may involve internal fixation with screws or pins
  • Patient may need to wear a cast or splint for a period of time after surgery
  • Patient undergoes physical therapy to regain strength and range of motion in the wrist
  • Patient may need follow-up appointments to monitor healing and progress
  • Full recovery may take several months

Overall, the timeline for a patient with a scaphoid fracture can vary depending on the severity of the injury, the treatment approach, and individual healing factors. It is important for patients to follow their doctor’s recommendations for treatment and rehabilitation to achieve the best possible outcome.

What to Ask Your Doctor

Some questions a patient should ask their doctor about scaphoid fracture surgery include:

  1. What are the potential risks and complications associated with scaphoid fracture surgery?
  2. How long is the recovery period following scaphoid fracture surgery?
  3. Will I need physical therapy or rehabilitation after the surgery?
  4. What type of anesthesia will be used during the surgery?
  5. How long will I need to stay in the hospital after the surgery?
  6. Will I need to wear a cast or brace after the surgery? If so, for how long?
  7. What is the success rate of scaphoid fracture surgery?
  8. What type of follow-up care will be needed after the surgery?
  9. Are there any alternative treatments to surgery for a scaphoid fracture?
  10. How soon after the injury should surgery be performed for optimal outcomes?

Reference

Authors: Karir A, Huynh MNQ, Carsen S, Smit K, Cheung K. Journal: Hand (N Y). 2022 May;17(3):459-464. doi: 10.1177/1558944720930293. Epub 2020 Jul 1. PMID: 32609009