Pediatric Scaphoid Fracture

Etiology: Trauma
Imaging Radiograph: Obliterated fat plane adjacent to the scaphoid can be an important clue
Note: Easy to miss on radiographs even when using dedicated scaphoid view and therefore radiographs cannot exclude acute scaphoid fracture so if snuff box tenderness persists get followup radiographs 2 weeks after injury to look for signs of healing
Imaging CT: Can confirm or exclude acute fracture
Imaging MRI: Can confirm or exclude acute fracture
DDX:
Complications:
— Nonunion – usually of scaphoid waist fracture
— Avascular necrosis of proximal pole of scaphoid
Treatment:
Clinical: Scaphoid is most common carpal bone fracture

Radiology Cases of Scaphoid Fracture

Radiograph of scaphoid fracture — AP radiograph of the wrist shows a thin lucent line through the center of the scaphoid bone. On physical exam the patient had point tenderness over this area.

Radiograph of scaphoid fracture — AP radiograph of the wrist (left) shows a double density over the scaphoid bone. Scaphoid view (right) shows a lucency through the waist of the scaphoid bone with displacement of the fracture fragments.

Radiograph of scaphoid fracture — AP radiograph of the wrist shows a lucent line with some adjacent sclerosis through the waist of the scaphoid bone.

Radiograph of scaphoid fracture — AP (left) and oblique (right) radiographs of the wrist show a lucent line through the scaphoid tubercle.

Radiograph and MRI of pediatric scaphoid fracture of waist of scaphoid — AP (above left) and scaphoid (above right) radiographs of the wrist do not show a fracture line through the scaphoid. On the AP view of the scaphoid there is a mild irregularity in the radial border of the scaphoid. Coronal T1 MRI without contrast of the wrist obtained 2 weeks later (below left) shows low signal intensity in the waist of the scaphoid, while T2 MRI (below right) shows high signal intensity in the waist of the scaphoid and in the proximal radius.