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Treatment of Acute Seymour Fractures
James S Lin1, James E Popp1,2, Julie Balch Samora1,2
1The Ohio State University Wexner Medical Center.
Insights
Most pediatric Seymour fractures, a type of distal phalanx fracture, can be treated effectively in the emergency department (ED) with non-operative management. Surgical intervention is typically reserved for cases with unstable or unsuccessful reduction, with good outcomes generally achieved.
Area of Science:
- Pediatric Orthopedics
- Traumatology
- Emergency Medicine
Background:
- Seymour fractures are juxta-epiphyseal distal phalanx fractures in children.
- Optimal management strategies, including antibiotic choice and operative indications, require further definition.
Purpose of the Study:
- To investigate treatments, outcomes, operative indications, and antibiotic choices for acute Seymour fractures.
- To define optimal management protocols for these pediatric fractures.
Main Methods:
- Retrospective study of pediatric patients (<18 years) with acute Seymour fractures (2009-2017).
- Outcomes assessed included management, antibiotic type, infection, healing, malunion, physeal disturbance, nail dystrophy, and need for operative intervention.
- Study level IV, therapeutic.
Main Results:
- 65 fractures in children (mean age 10 years) were analyzed.
- 89% of fractures were initially managed non-operatively in the emergency department (ED).
- Unsuccessful closed reduction was the primary indication for operative intervention; 4 ED-managed cases required unplanned surgery for redisplacement. Complications were infrequent.
Conclusions:
- Acute Seymour fractures in children can often be successfully managed non-operatively in the ED.
- Stable reduction is key for successful non-operative management.
- Operative intervention is indicated for unstable or unsuccessful reductions.
Background:
Seymour fractures are distal phalanx fractures in children with a juxta-epiphyseal pattern. The purpose of our study was to investigate the treatments, outcomes, operative ;indications, and antibiotic choice for acute Seymour fractures (presenting within 24 h of injury), to better define optimal management. We hypothesized that: (1) cephalexin provides adequate antibiotic coverage for acute Seymour fractures; (2) most injuries will achieve good outcomes with management in the emergency department (ED) alone; and (3) indication for operative intervention is unsuccessful or unstable reduction in the ED.
Methods:
We performed a retrospective study of patients under 18 years old treated at a large pediatric hospital from 2009 to 2017 for an acute Seymour fracture. Study outcomes included management and antibiotic type, infection, fracture healing, malunion, physeal disturbance, nail dystrophy, antibiotic failure, and need for unplanned operative intervention.
Results:
Mean age of patients was 10 years, with 43 males and 22 females sustaining 65 Seymour fractures. Fifty-eight cases (89%) were initially managed in the emergency department. Seven cases were initially managed with an operative intervention that included I&D, open reduction, and K-wire fixation. The most commonly cited surgical indication was unsuccessful closed reduction. Four patients initially managed in the ED required an unplanned operation, usually because of fracture redisplacement. Complications were rare, with superficial infections being most common.
Conclusions:
Most acute Seymour fractures can be successfully managed in the emergency department if stable reduction is achieved.
Level Of Evidence:
Level IV, therapeutic.
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