SJH Emergency Medicine
Definite scaphoid fractures should be placed in a full below elbow soft scaphoid cast and referred to paediatric TTC. If they present out of hours use a wrist splint with thumb extension and bring back to the next plaster technician clinic for a full scaphoid cast.
Paediatric carpal / scaphoid bone injuries
Warning
Fractures of the carpal bones are relatively rare in children. Small avulsion fractures can usually be treated in a below elbow soft cast and referred to the Trauma Meeting.
Tenderness in the anatomical snuffbox (ASB) in a child over 8 yrs of age should be investigated with scaphoid X-rays, not a forearm view, although scaphoid fractures are rare under 12 yrs of age.
Clinical scaphoid fractures are diagnosed with tenderness in the ASB / scaphoid tubercle, with reduced wrist movements but no X-ray abnormality.
These should be treated in a wrist splint without extension, given the clinical scaphoid advice leaflet and advised to call the number on the leaflet at 2 weeks if ongoing problems. The vast majority of these will settle in this time but this allows the diagnosis of small, undisplaced fractures that may be radiographically silent on the initial films and appropriate follow up with the orthpaedic team if required.