EARLY MOBILIZATION OF SUSPECTED SCAPHOID INJURIES IN CHILDREN

Children presenting with suspicion of a scaphoid fracture but normal radiographs are common. To mitigate the risk of missing an occult fracture, management is largely divided between empiric immobilization vs. early advanced imaging. Scaphoid fractures only detectable on advanced imaging, however, may be clinically insignificant and at low risk for complications such as non-union. As such, a third option may exist. We aim to evaluate the benefits and feasibility of an early range of motion (ROM) protocol in these children. Less restrictive treatment with an early ROM protocol may result in improved function, earlier return to activity, and fewer follow up visits and imaging. A prospective study was performed. Children with a clinically suspected scaphoid fracture but normal radiographs at least 10 days after injury were treated with a removable wrist brace and an early ROM protocol. CT was obtained to confirm the presence or absence of a scaphoid fracture. Patients were evaluated at 6 weeks- and 26-weeks post-injury with radiographs and patient reported outcomes measures (PRWHE and PROMIS). Thirty-nine patients were enrolled. Mean age was 12.4 (SD=2.0) years. Fifteen of the patients (38%) had scaphoid fractures confirmed on CT despite normal radiographs. All participants tolerated the early ROM protocol. The retention rate of patients with a confirmed or equivocal scaphoid fracture on CT was 93.3, 95% CI [70.2, 99.7] and 80.0, 95% CI [54.8, 93.0] at 6- and 26-weeks, respectively. Median PRWHE scores improved from 44.2 at baseline to 9.2 and 0 at 6- and 26-weeks post-injury, respectively. There were no instances of non-union, AVN, or other adverse events. The optimal treatment strategy of children with suspected scaphoid fractures but normal radiographs remains unclear. This study suggests the potential of an early ROM protocol in the management of these patients. Based on these results, a larger adequately powered trial to confirm the safety and effectiveness of an early ROM protocol is feasible.