Explanation

Scaphoid fractures are relatively uncommon in children but are at risk of nonunion, can cause significant long-term pain, and may have normal initial X-rays. The arterial supply of the scaphoid bone enters distally leading to decreased blood and nutrient supply proximally. A fracture through the proximal or waist (central ⅓) of the bone can decrease blood supply further, especially if the artery is disrupted. This causes poor healing conditions which can lead to nonunion or osteonecrosis. In addition, many scaphoid fractures are extremely difficult to visualize on X-ray and swelling is not always present on exam. Patients with a scaphoid fracture may only have pain at the anatomical snuffbox after a fall onto an outstretched hand. Current recommendations are to place such patients in a thumb spica splint and refer to outpatient orthopedics to determine the need for further immobilization and repeat X-rays in two weeks.

Discharging with no immobilization (A) is inappropriate in patients with snuffbox tenderness due to possible morbidity from an easily missed diagnosis. A sugar-tong splint (B) wraps along both sides of the forearm and is often used in distal forearm fractures but does not appropriately immobilize the thumb. An ulnar gutter splint (D) is usually used for phalangeal and metacarpal fractures and also does not immobilize the thumb.