Adam W. Anz, Brandon D. Bushnell, Donald K. Bynum, George D. Chloros, and Ethan R. Wiesler J Am Acad Orthop Surg 2009 17: 77-87
Fractures of the immature carpal scaphoid can be challenging to manage. The diagnosis may be missed or delayed because of absent or minimal symptoms. Once diagnosed, most pediatric scaphoid fractures can be successfully treated with cast immobilization. However, this is inadequate for difficult and unique cases. Nonunion may occur as a result of a missed diagnosis or delayed presentation as well as in patients who receive appropriate treatment. Because the natural history in children remains incompletely characterized, the optimal treatment of established pediatric scaphoid nonunions is controversial. Surgical intervention should be considered for displaced fractures in patients who are at or near skeletal maturity or in those in whom nonsurgical treatment has failed.