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I'm looking for information on scaphoid wrist fractures in children. I'm finding terms I don't quite understand such as acute, chronic, high-energy, low-energy -- can you help me understand what these all mean?
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First, let's start with the type of wrist fracture you are asking about. The scaphoid bone is on the thumb side of the hand. It is located at the end of the forearm with just one small bone (the trapezium) between the scaphoid and the base of the thumb.
The scaphoid is the bone fractured most often in the wrist. It is kidney shaped with three distinct fracture patterns involving the middle of the bone called the waist and the two ends on either side called poles.
The distal pole (thumb side) and the proximal pole (wrist side) make up the two other segments. The bone isn't really divided anatomically into three parts -- it is just shaped in such a way that makes it easy to categorize fractures based on their location in any of these three locations.
An acute fracture is one that has occurred (and was treated) in the last six weeks. A chronic (sometimes called late-presenting) fracture is one that is not diagnosed and/or treated until more than six weeks after the injury.
Most scaphoid wrist fractures in children are high-energy injuries. In other words, the event that caused the fracture involved trauma that occurred quickly and often with a lot of weight behind it. Speeding along on a skateboard or snowboard and taking a sudden fall, for example. Or having someone three times your size tackle you while playing football or extreme soccer.
Low-energy fractures are more likely to occur when a person falls from a stationary or standing position (e.g., losing your balance and falling off a stool or ladder or tripping over a crack in the sidewalk and falling on the outstretched hand/wrist).
Other terms you might come across as you read about fractures include displaced (two ends of the fracture separate) and reduction (surgeon puts the bone back together and holds it in place with wires, screws, and/or a cast).
Fractures in children can also involve the physes (growth plates) so you might see that word in your reading. With younger children involved in these sports, there is always a concern about the effect of the fracture on the physes. A fracture through the growth plate could alter the bone growth and result in a shorter wrist/hand on that side.
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