Pediatric emergency medicine trisk 3361 3361

Most suspected injuries to the carpal bones can be managed in the urgent
setting with splinting and outpatient follow-up within 1 to 2 weeks. Scaphoid
fractures have different patterns depending on the age of the patient. Younger
patients have a significant incidence of fractures involving the distal third of the
bone, although fractures in the middle third (i.e., the waist) are still the most
common in children. Adolescents and adults tend to fracture at the waist of the
scaphoid. A unique fracture to young patients is the avulsion of the distal radial
aspect of the scaphoid. This injury often is not diagnosed on first presentation and
is seen on radiographs 1 to 2 weeks later.
In the emergency department, confirmed and suspected scaphoid fractures
should be managed with a thumb spica splint or cast. Most scaphoid fractures are
nondisplaced and ultimately managed with cast immobilization, though displaced
fractures may require surgical reduction and internal fixation to prevent
nonunion. In addition, those who present late with evidence of nonunion should
be immobilized and referred to a hand specialist for possible surgical repair.