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Scaphoid nonunion is relatively rare in children and adolescents, and no long-term follow-up has been reported.Retrospective follow-up study.Eleven patients (10 boys and 1 girl), mean 15.2 (13.9-15.9) years of age, with scaphoid nonunion and open growth plates were operated with bone grafting, Kirschner-wire fixation and 12 weeks of cast immobilization.Bony union, degenerative wrist changes, and restoration of the carpal architecture were assessed with CT and radiographs. Clinical parameters included active range of motion, grip strength, key pinch strength, and subjective outcome scores (quick disabilities of arm, shoulder and hand (DASH), visual analog scale).The patients were followed up after mean 6.9 (3.1-15.1) years; all patients attended. Radiographs and CT confirmed healing of all nonunions, the carpal anatomy was restored, and the wrists were rated as 0 according to the scaphoid nonunion advanced collapse, without degenerative changes. The clinical result was excellent with visual analog scale at rest = 1, at activity = 6, and quick DASH score = 3.3. Active range of motion and grip strength were insignificantly reduced (14 degrees and 2 kg); the key pinch strength remained similar.Healing of a scaphoid nonunion can be expected in adolescents after open reduction, Kirschner-wire fixation, bone grafting, and plaster immobilization, resulting in pain relief and excellent wrist function without degenerative changes after longer term follow-up.Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Neurovascular injuries in children with dislocated supracondylar humeral fractures are not uncommon. Closed reduction and pin fixation usually will restore the circulation. In some patients, there is still compromised circulation and a neurologic deficit, and they are treated with open exploration and microvascular reconstruction. We have investigated the clinical and functional outcome more than 1 year after the injury in this most serious group of patients.Retrospective follow-up study.During 2001 to 2007, five patients were referred to our department with a pale, pulseless hand and circulatory impairment with absent or slow capillary refill after primary treatment with closed reduction and cross pinning at their local hospital for Gartland Type III supracondylar fractures. Two of the patients also had clinical signs of nerve injury.All were reoperated on with open exploration and release of the entrapped brachial artery. Vascular reconstruction was performed in four patients (vasodilating agent was sufficient in one patient) and release of the median nerve from the fracture in two. One of these two also had a Kirschner wire pierced through the ulnar nerve. All fractures were rereduced and cross-pinned. No intra- or postoperative complications were seen. OUTCOME/RESULTS: At follow-up more than 1 year after the injury, all patients exhibited normal and symmetric function in their upper extremities, including circulation, neurologic status, range of motion, grip strength, and key pinch strength. Clinical and radiologic appearance was normal.Pulseless arms after repositioning of dislocated supracondylar humeral fractures are a medical emergency. After open release and, if necessary, microvascular reconstruction of vessels and nerves, fracture reduction, and fixation, excellent clinical long-term outcome can be expected. The procedure can be carried out with a low rate of complications.

Untreated scaphoid nonunions are a hazard to the wrist, resulting in deteriorating function and radiologic degenerative changes with increasing time. Long-term results after surgery of scaphoid nonunion reporting clinical, radiologic, and subjective outcomes are scarce.Retrospective follow-up study.From 1990 to 1998, 53 patients were operated on for persistent scaphoid nonunion; three patients were excluded from the follow-up (one expelled foreigner, another died of an unrelated cause, one never appeared after surgery), leaving 50 patients eligible for follow-up.All patients were operated on with open reduction and internal fixation; the majority also received a bone graft.Radiology and computed tomography verified union, degenerative wrist changes, and final salvage treatment. Range of motion, grip strength, key pinch, and subjective outcome (QuickDASH, visual analog scale).Fifty patients were followed up after a mean of 12.2 years (standard deviation [SD], 3.0), 47 by clinical and radiologic examination; three were interviewed by telephone and completed QuickDASH and visual analog scale forms. Union was achieved in 45 of 50 scaphoids and an additional two after a second attempt. Five patients (one persistent and four healed nonunions) underwent salvage procedures. Grip strength (41 vs 45 kg, P = nonsignificant), key pinch (11.5 vs 12.4, P = nonsignificant), and active range of motion (186° vs 214°, P0.001) were slightly reduced compared with the uninjured side. The subjective outcome was good (mean visual analog scale = 7, mean QuickDASH = 9.1). Minor degenerative changes were seen in nine wrists at surgery and 22 at follow-up.Healing of a scaphoid nonunion provides long-term pain relief, excellent wrist function, and halts degenerative changes in the majority of patients.Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.