Percutaneous Fixation And Bone Grafting Of Paediatrics Scaphoid Non-Unions

Objectives: Paediatric non-unions of scaphoid fractures are rare. We report a minimally invasive percutaneous technique with bone graft, which results in satisfactory union of the scaphoid fracture with minimal morbidity. Material and methods: Four patients, all boys with a mean age of 14.6 years presented with symptomatic un-united B2 fractures through the waist of the scaphoid due to trauma. Preoperative radiographs confirmed the presence of scaphoid non-union and the pattern and extent of the non-unions were evaluated on CT scan. All fractures were fixed with a minimally invasive percutaneous technique involving supplementary use of autologous bone graft harvested from the ipsilateral iliac crest and Acutrak screws. Results: The average operating time was 30 minutes. There were no intraoperative or postoperative complications. The wrist was immobilised in a splint after the operation for two weeks during which time gradual rehabilitation was started. All fractures healed clinically and radiologically at 10 weeks postoperatively. Range of movement, grip strength and functional scores were excellent at the 3 months review. There have been no cases of avascular necrosis or reoperation. Conclusion: Percutaneous fixation and autogenous bone grafting of paediatric scaphoid non-unions is a novel technique with excellent results and minimal morbidity. We recommend this technique as an alternative to standard volar (Russe) bone graft in cases of scaphoid non-union in children.