Seymour fracture: Better do not underestimate it

Abstract

Objectives: This study aims to analyze the functional results,management, and complications of acute Seymour fracturetreatment and to generalize the understanding of Seymourfractures, as well as awareness about its controversial treatmentand critical sequelae. Patients and methods: Between January 1994 andDecember 2019, a total of 29 patients (20 males, 9 females;mean age: 7.9±3.9 years; range, 1 to 15 years) who presentedwithin the first 24 h of injury and were diagnosed withSeymour fractures and treated in the emergency setting wereretrospectively analyzed. Clinical and radiological data werecollected from medical records at the time of diagnosis andduring follow-up, within a week after the treatment and in thevisits required until fracture healing, and no sequelae wereobserved. In the event of complications, a minimum of one yearof follow-up was carried out. Radiographs were taken of theanteroposterior and lateral views during each visit. Results: The mean follow-up was 10.8±8.6(range, 2 to 36) months. Surgical treatment in the operatingroom was performed in 24 (82.7%) patients using a singlelongitudinal Kirschner wire (K-wire) fixation throughthe distal phalanx and the distal interphalangeal joint in21 patients. Non-operative treatment based on closed reductionand splinting was performed in five (17.3%) patients. Therewas no statistically significant difference in the final passiverange of motion and physeal growth arrest in relation to theuse or non-use of K-wires. The use of antibiotics in any ofthe three possible administrations (intravenous antibioticregimen, intravenous and later oral antibiotic at-home or oralantibiotics), in relation to the non-use of antibiotics seemed tobe a protective factor against infections (odds ratio=0.04; 95%confidence interval: 0.006-0.2; p=0.001). Conclusion: The identification of Seymour fractures is crucialfor applying the correct treatment and reducing the risk ofcomplications, such as osteomyelitis and physeal alterations.Based on our study results, we can suggest that the use of anantibiotic regimen causes a lower risk of infections in acuteSeymour fractures. The prompt identification of these fractureswith a standardized protocol covering irrigation, debridement,reduction, fixation, and prophylactic antibiotics is needed to avoidcomplications.