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Abstract：
Background Scaphoid fractures represent less than 3% of hand and wrist fractures in the pediatric population. Nonunions are very rare. We present a case series ( n = 18) of nonunions in skeletally immature children and adolescents. We further present a review of the literature on pediatric scaphoid nonunions. Materials and Methods We reviewed the literature by searching the main databases on pediatric scaphoid nonunions, but to identify factors that lead to nonunion, we also searched for databases on scaphoid fractures. Seventy articles were found for the period between 1961 and 2019, all with level 4/5 evidence. Results The nonunion rate of pediatric scaphoid fractures in the literature is on average 1.5%, occurring mostly as a result of missed or underdiagnosed injuries, similar to our presented case series. Half ( n = 9) of the injuries in our case series were missed initial injuries, leading to scaphoid nonunions and half developed nonunions after initial treatment. We found excellent outcomes and with surgical and nonoperative management, with few complications. Not surprisingly, the duration of immobilization is longer with nonoperative management. Conclusions Based on the literature, we recommend a period of nonoperative management before surgery in undisplaced nonunions. In displaced nonunions, open reduction and internal fixation ± bone grafting is necessary. In pediatric scaphoid fractures, similar to adult cases, we identified that suspicious scaphoid fractures should be considered for initial immobilization, and repeat X-rays and early magnetic resonance imaging (MRI) or computed tomography (CT) scans should be considered at follow-up. Immobilization time and type of plaster should be appropriate in relation to the fracture site, similar to the adult scaphoid fracture. Level of Evidence This is a Level IV study.
摘要：
背景：在儿童人群中，舟骨骨折占手部和腕部骨折的比例不到3%。不结合是非常罕见的。我们介绍了骨骼不成熟儿童和青少年不愈合的病例系列（n=18）。我们进一步回顾了有关小儿舟骨骨不连的文献。材料与方法我们通过检索小儿舟骨骨不连的主要数据库进行文献综述,但是为了找出导致骨不连的因素，我们还搜索了有关舟骨骨折的数据库.在1961年至2019年期间发现了70篇文章，所有文章都有4/5级证据。结果文献中小儿舟骨骨折的骨不愈合率平均为1.5%,主要是由于错过或未被诊断的伤害，类似于我们提出的案例系列。在我们的病例系列中，一半（n=9）的受伤被错过了最初的受伤，导致舟骨骨不连，一半在初始治疗后出现骨不连。我们发现良好的结果和手术和非手术治疗，很少有并发症。毫不奇怪,非手术治疗的固定时间更长。结论根据文献，我们建议无移位骨不连患者在手术前进行一段时间的非手术治疗.在流离失所的不结合中，切开复位内固定±植骨是必要的。小儿舟骨骨折，类似于成人病例，我们发现可疑的舟骨骨折应该考虑进行初始固定，随访时应考虑重复X射线和早期磁共振成像（MRI）或计算机断层扫描（CT）。固定时间和石膏类型应与骨折部位有关，类似于成人舟骨骨折。证据水平这是一个IV级研究。
