Functional and Radiologic Outcomes of Non-Displaced Scaphoid Waist Fractures in Adolescents Approaching Skeletal Maturity: Comparison Between Conservative Treatment and Percutaneous Screw Fixation

Background: Treatment of scaphoid waist fractures is generally conservative in children but surgical in adults, given the relatively high risk of nonunion in adults. In adolescents, the required therapeutic strategy is less well defined. The objective of this study was to compare the radiographic and clinical parameters, and the rate of complications, between non-surgical orthopedic treatment (OT) and surgical treatment (ST) by percutaneous screw fixation of these fractures in adolescents approaching skeletal maturity. Hypothesis: ST of non-displaced scaphoid waist fractures in adolescents allows radiographic union, a functional result and a complication rate comparable to that of ST. Methods: This single-center retrospective study included patients who presented with a non-displaced scaphoid waist fracture, with a chronological age (CA) and a bone age (BA) between 14 and 18 years. Clinical and radiographic parameters and complications were analyzed during the trauma and at one year, including functional scores, between two groups of patients; OT and ST. Results: Thirty-seven patients had OT (63.8%) and 21 had ST (36.2%). The median CA was 16 years [14.25-16]. The median BA was 16 years [15;17] according to the Greulich and Pyle method and corresponded to R9 [R7-R10] and U7 [U7;U8] according to the Distal Radius and Ulnar (DRU) classification system. All nonunions were found in the OT group (23.4% vs 0%, p=0.019). The duration of immobilization (8 weeks) and the number of consultations were higher after OT than ST. Functional scores were lower in patients with nonunion after OT (p≤0.002) Conclusion: OT of scaphoid waist fractures in adolescents results in a higher rate of nonunion than ST, similar to the rate found in adults. Findings from this study recommend a surgical approach by percutaneous screw fixation. Level of evidence: III; comparative retrospective study.