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I'm a frustrated sports mother. Just found out my 19-year-old son has had a broken wrist bone (evidently the scaphoid bone) for the last six months. He's on a soccer scholarship at a local college but does not live at home. Nothing was done to treat it and it hasn't healed on its own. Now he's going to need more expensive surgery when he could have gotten over this in six weeks with a cast. What's wrong with these kids anyway that they don't let someone know something is wrong?

You aren't the first parent to ask that question! Does anyone really know the mind of 18-year-olds? But to help you out as much as possible, here are several factors that might help explain your son's situation. First, the scaphoid is the most common carpal bone to break. It is located on the thumbside of the wrist next to the radius (larger of the two forearm bones). Studies have reported a nonunion rate as high as 40 per cent. This high rate occurs when the patients are not diagnosed or treated right away. To give you an idea how that 40 per cent rate compares, there's a three per cent rate of nonunion when the problem is diagnosed and treated within 30 days of the injury. This finding supports the idea that timing of evaluation and treatment might be an important factor. You have probably already figured that out with your son's situation! The real question is how do these young athletes keep on playing with a broken wrist? The truth is that quite a few of these fractures don't cause painful symptoms at all. In a recent study from Canada, one-third of a group of 96 patients with scaphoid fractures did not seek medical attention. They either didn't think it was much of a problem or the painful symptoms got better without treatment. Pressure to return to sports participation in this age group may have led some to minimize their symptoms. In those patients who were evaluated, the diagnosis was missed because there is a high rate of false negative response when relying on X-rays. In other words, the X-rays don't show the fracture. Even with timely cast immobilization, scaphoid fractures don't always heal. Surgery is required anyway. So although you can't know how your son's injury would have responded with early treatment, there's a good chance he would have required surgery anyway. Hopefully, this will put him well on the road to recovery now.

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