Union outcomes and associated factors in adolescent scaphoid fractures

PURPOSE: Scaphoid fractures (SF) in adolescents differ from adult fractures in fracture pattern, healing capacity, and skeletal maturity. Limited data exist on factors affecting union and healing time in this population. This study evaluated clinical, radiological, and treatment-related factors associated with union and healing time in adolescent SF. METHODS: This study included 77 adolescents (aged 10-18 years) treated for SF. Chronological age, bone age, fracture characteristics, treatment modality, union status, and healing time were recorded. Fractures were classified by anatomical location, displacement, and time to diagnosis (< 6 weeks or ≥ 6 weeks). CT-based morphometric measurements, including scaphoid height, lateral intrascaphoid angle, and dorsal cortical angle, were obtained from initial computed tomography images. Functional outcomes were assessed using the QuickDASH and patient-rated wrist evaluation (PRWE) scores. RESULTS: Union was achieved in 63 patients (81.8%), with a median union time of 8 weeks (range, 6-10 weeks). Union rates were highest in distal pole fractures (100%) and lowest in proximal pole fractures (33.3%). Non-displaced fractures had higher union rates than displaced fractures (92.5% vs. 56.5%), and fractures diagnosed within 6 weeks demonstrated better union outcomes. Surgical treatment, performed in 16.9% of patients, was associated with lower union rates and longer healing times. Younger chronological and bone age correlated with higher union rates, shorter immobilization, and improved functional scores. Increased scaphoid height, lateral intrascaphoid angle, and dorsal cortical angle were associated with prolonged healing time and reduced union rates. CONCLUSION: Healing of SF in adolescents is influenced by fracture characteristics, skeletal maturity, and scaphoid morphology. Younger age and favorable morphometric parameters are associated with improved healing outcomes. Scaphoid morphometric measurements may offer additional prognostic value in adolescents and should be further evaluated in larger prospective studies.