Children Play the Game and Pay the PriceSome injuries that are rare in adults are starting to show up in children. This may happen because of increased participation in sports and increased intensity of play. Wrist fracture is one of the potential injuries that may result from a fall onto the hand or having blunt trauma to the wrist.
At the base of the thumb are the radius (radial) bone of the forearm and the scaphoid bone of the wrist. When the thumb is stuck out in a hitchhiker's pose, there is a dent in the skin at the bottom of the thumb. This is called the "snuffbox." The scaphoid bone is inside this space. Nonhealing fractures of this bone in children have now been reported for the first time. Doctors at Children's Hospital in Boston reported three cases between 1993 and 1996.
When the scaphoid bone is broken, the blood supply may be cut off, causing the bone to slowly die. Surgery is needed to remove the dead bone and replace it with a live bone graft. One method of bone graft is to take the donor bone from the radial bone just above the thumb. Wires are used to hold the graft in place until it heals. This method improves healing.
Painful wrist symptoms that last months after a fall on the hand could be from a broken scaphoid bone. Delayed diagnosis can occur because this is a rare injury in children. Doctors may expect to see more injuries of this type in children as the sports craze continues.
Peter M. Waters, MD, and Susan L. Stewart, MD. Surgical Treatment of Nonunion and Avascular Necrosis of the Proximal Part of the Scaphoid in Adolescents. In The Journal of Bone and Joint Surgery. June 2002. Vol.84-A. No. 6. Pp. 915-920.
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