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Updated: Sep 21, 2026
Creating Rigidly Stabilized Fractures for Assessing Intramembranous Ossification, Distraction Osteogenesis, or Healing of Critical Sized Defects
Published on: April 11, 2012
NEGLECTED SEYMOUR FRACTURES OF THE HALLUX IN CHILDREN: FIXATION VERSUS NO FIXATION, AND TRANSARTICULAR VERSUS
Ibrahim Halil Demir1, Nevzat Gonder2, Beytullah Unat3
1T.C. Gaziantep City Hospital, Gaziantep, Turkey, 27500, Department of Orthopaedics and Traumatology.
Background:
Open Seymour fractures of the hallux, distinct from closed physeal injuries, lack a clear optimal stabilization strategy when presentation is delayed.
Purpose:
To compare reduction maintenance and recovery of interphalangeal (IP) motion after three operative strategies for neglected, open hallux Seymour fractures.
Study Design:
Retrospective comparative cohort study.
Methods:
Forty-four children presenting more than 48 hours after injury underwent irrigation, debridement, and nail bed repair, with transarticular fixation (TFx, n=16), extra-articular crossed-wire fixation (EFx, n=17), or no skeletal fixation (NoFx, n=11). Minimum follow-up was 12 months. Categorical outcomes were compared with exact tests; continuous outcomes with Kruskal-Wallis tests and adjusted pairwise comparisons.
Results:
Loss of reduction occurred in 5/11 NoFx patients versus 0/33 fixed patients (p < 0.001). Median time to full IP motion was 77 days in TFx versus 56 days in both EFx and NoFx (TFx vs EFx, p = 0.002 after adjustment). Physeal alteration occurred in 3/16 TFx, 3/17 EFx, and 7/11 NoFx patients (overall p = 0.027), though pairwise comparisons were not significant. All 5 patients with loss of reduction had physeal alteration, versus 8/39 without (exploratory p = 0.001). Osteomyelitis occurred in 12/44 patients and correlated with longer treatment delay.
Conclusions:
Fixation was associated with maintained reduction in this neglected, open-injury cohort. Extra-articular fixation showed earlier recovery of full IP motion than transarticular fixation, with no loss of reduction in either fixed group. These findings support joint-sparing fixation when feasible but do not establish causal superiority or identify which fractures may safely remain unfixed.
Level Of Evidence:
Level III, retrospective comparative study.
