Nonunion Rates in Nonoperatively Managed Adolescent Scaphoid Fractures Using a National Database

Pediatric scaphoid fractures are uncommon and typically amenable to nonoperative management. However, true nonunion rates in this population remain unclear, especially in the setting of evolving injury mechanisms and patient characteristics. In particular, the impact of fracture location on nonunion has not been well studied in adolescents. We conducted a retrospective cohort study using the TriNetX Research Network. We included patients aged 12 to 18 years diagnosed with scaphoid fractures between 2010 and 2024 who were managed nonoperatively. Fractures were stratified by anatomic location into proximal pole, waist, and distal pole using ICD-9-CM and ICD-10-CM codes. The primary outcome was fracture nonunion within 1 year. Secondary outcomes included chronic wrist pain, opioid utilization, and referral to occupational or physical therapy. Kaplan–Meier methods were used to estimate 1-year cumulative incidence. A total of 16,022 adolescents with nonoperatively managed scaphoid fractures were identified. The overall 1-year cumulative incidence of nonunion was 2.17%. Among patients with fractures isolated to a single anatomic region (n = 4,268), nonunion rates varied markedly by location: 1.74% for distal pole fractures, 10.75% for waist fractures, and 24.22% for proximal pole fractures. Secondary outcomes demonstrated similar anatomic gradients, with high opioid use and occupational or physical therapy referrals for proximal pole injuries. Nonunion following nonoperative management of adolescent scaphoid fractures is overall rare but varies substantially by fracture location. While distal pole fractures demonstrated low nonunion rates, proximal pole and waist fractures were associated with trending higher rates of nonunion and may benefit from greater clinical vigilance during immobilization. Overall, these findings can help inform individualized counseling and follow-up plans for adolescents presenting with scaphoid fractures. III, retrospective cohort study.