title: The pediatric fracture of the scaphoid in patients aged 13 years and under: an epidemiological study.
abstract: BACKGROUND
  Fractures of the scaphoid are uncommon in the pediatric population. Despite their rarity, a significant number of children are referred to the fracture clinic for a suspected scaphoid fracture. The aim of this study was to report on the current incidence, pattern of injury, and the long-term outcomes following this injury in the pediatric population.
  
  
  METHODS
  Analysis of all pediatric scaphoid fractures presenting to a tertiary pediatric hospital (aged 13 y and under) over a 5-year period was performed. The case notes, radiographs, and other imaging studies for these patients were reviewed. Long-term functional outcome was assessed using Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.
  
  
  RESULTS
  Fifty-six patients of the 838 (6.7%) referred for a suspected scaphoid fracture were identified as having a confirmed diagnosis of a scaphoid fracture, giving an average annual incidence of 11 per 100,000. This group consisted of 39 boys (70%) and 17 girls (30%). The average age of incidence in boys was 12.2 years and in girls was 10.3 years (P<0.001). No scaphoid fractures were observed in boys below the age of 11 years and in girls below the age of 9 years. The most common type of fracture was a distal pole fracture (45 patients). One patient sustained a proximal pole fracture and went on to develop a nonunion. The duration of treatment in cast was shorter in distal pole fractures than in other types (P<0.001). At a mean follow-up of 70 months (range, 46 to 104 mo), 60% reported no limitation or impact when reporting a range of daily functional activities (mean DASH score=3.0).
  
  
  CONCLUSIONS
  There is a suggestion that the overall incidence of scaphoid fractures in the pediatric population is increasing, but children aged 13 years and under continue to maintain a distinct fracture pattern when compared with adolescents and adults. The majority involves the distal third of the scaphoid and carries a good prognosis with conservative management.
  
  
  METHODS
  Prognostic study, Level 4.
authors.affiliation: The Royal Hospital of Sick Children, Edinburgh, Scotland, UK.
authors.forename: Issaq
authors.initials: I
authors.lastname: Ahmed
authors.forename: Fiona
authors.initials: F
authors.lastname: Ashton
authors.forename: Wy Keat
authors.initials: WK
authors.lastname: Tay
authors.forename: Daniel
authors.initials: D
authors.lastname: Porter
mesh_terms: D000293:Adolescent; D002370:Casts, Surgical; D002648:Child; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D015994:Incidence; D008297:Male; D011379:Prognosis; D011859:Radiography; D012189:Retrospective Studies; D021361:Scaphoid Bone / Q000000981:diagnostic imaging / Q000293:injuries*; D012606:Scotland / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014954:Wrist Injuries / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy