Journal of Pediatric Orthopaedics - 2026-07-02 - Journal Article
Pediatric Nonscaphoid Carpal Fractures: Fracture Distribution and Operative Management in an Institutional Cohort and 2 National EHR Databases.
Flood MG, Rice S, Khan A, Walsh H, Garcia-Owusu A, Tanner N, Coombs H, DeFazio M, Mortimer E
Topics
Key Takeaway
Pediatric nonscaphoid carpal fractures are rare and predominantly nonoperative, with hamate fractures comprising 33.3–33.9% of cases in national EHR databases and representing the most common bone requiring surgical intervention.
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Summary
This study characterized fracture distribution and operative rates for pediatric nonscaphoid carpal fractures using one Level I trauma center (2017–2025) and two national EHR databases (TriNetX, Epic Cosmos; 2015–2025). In the institutional cohort, 72.9% were male, triquetrum fractures were most common, and only 5 fractures in 4 patients required surgery (3 hamate, 2 trapezium). National databases confirmed triquetrum and hamate as the two most prevalent fractures, with hamate most frequently requiring operative intervention.
Key Limitation
The institutional cohort of 48 patients is underpowered to draw conclusions about complication rates, malunion, or functional outcomes by fracture subtype.
Original Abstract
BACKGROUND
This study aimed to characterize fracture distribution, demographic patterns, and operative management of pediatric nonscaphoid carpal fractures by leveraging a single institutional database and 2 large electronic health record (EHR) databases. We hypothesized that fractures would be more common among adolescent males and operative intervention would be rare.
METHODS
A retrospective review of patients under 18 years of age who presented to a single Level I trauma center with nonscaphoid carpal fractures between 2017 and 2025 was performed. Demographics, injury mechanism, fracture characteristics, diagnostic imaging modality, surgical intervention, and relevant complications were abstracted from the EHR. We then queried TriNetX and Epic Cosmos, 2 large deidentified health care databases, for pediatric patients with isolated nonscaphoid carpal fractures at academic medical centers between 2015 and 2025. The relative incidence of each carpal fracture was calculated as a percentage of all nonscaphoid carpal bone fractures. Operative intervention was evaluated using CPT codes.
RESULTS
The institutional cohort consisted of 48 patients with nonscaphoid carpal fractures. 72.9% were male, and triquetrum fractures were the most common fracture pattern. Only 5 carpal fractures (4 patients) were treated operatively (3 hamate, 2 trapezium). The TriNetX and Cosmos cohorts included 4464 and 2126 pediatric nonscaphoid carpal bone fractures, respectively. In TriNetX, hamate fractures were most common (33.3%), followed by triquetrum (28.5%), while in Epic Cosmos, triquetrum fractures were most common (36.3%), followed by hamate (33.9%). The vast majority of fractures were treated nonoperatively, with hamate fractures being the most common carpal bone to undergo surgical intervention.
CONCLUSIONS
Pediatric nonscaphoid carpal fractures are rare injuries, most commonly affecting adolescent males. Triquetrum fractures are the most common, while hamate fractures are most likely to be treated surgically.
LEVELS OF EVIDENCE
III-retrospective cohort/observational study.