Review Question - QID 219782

The patient has sustained a Seymour fracture with delayed presentation. These fractures, especially in the delayed setting, carry a high risk of post-traumatic osteomyelitis (Answer 3).

Seymour fractures are defined as open physeal injuries to the distal phalanx, often presenting with interposed soft tissue within the physis. Due to their nature as open fractures, they carry a high risk of infection and chronic osteomyelitis if not promptly recognized and treated appropriately. Urgent irrigation and debridement are crucial to minimizing the risk of associated post-traumatic infection. Surgical intervention involves the removal of any interposed tissue and pin stabilization as needed.

Abzug and Kozin published a 2013 review detailing the pathoanatomy, presentation, and treatment of Seymour fractures. The extensor tendon inserts into the epiphysis and the flexor tendon inserts into the metaphysis, resulting in a flexed posture resembling a mallet finger. Often germinal matrix tissue is found interposed in the fracture and must be extracted while ensuring no injury to the nearby extensor tendon insertion. Retrograde K-wire fixation is performed across the fracture site and DIP joint. Parenteral antibiotics are given, followed by a short course of oral antibiotics.

Samade et al. published a 2021 retrospective cohort study that investigated the outcomes of Seymour fractures with delayed presentations. The study included patients with delayed Seymour fracture presentations (defined as greater than 24 hours post-injury) evaluating time to presentation, infection on presentation, operative treatment, antibiotic use and duration, fracture union, and complications. The authors found that patients with a deep infection or inability to attain a stable closed reduction required formal surgical management. The preferred antibiotic for delayed Seymour fractures was clindamycin, due to its improved osseous penetration.

Rask et al. published a 2021 retrospective review determining the rates of infection in pediatric Seymour fractures. The overall infection rate was 27.3% (15/54 fractures). Among the 29 fractures that received antibiotics within 24 hours of injury, 2 infections (6.9%) were noted at the final follow-up. Delayed administration of antibiotics beyond 24 hours postinjury was associated with an increased infection rate of 76.5%; in contrast, early administration of antibiotics within 24 hours of injury was associated with reduced infections.

Figure A is a lateral radiograph of a Seymour fracture.

Incorrect Answers:
Answer 1: Seymour fractures typically present with flexion deformities.
Answer 2: While growth arrest is a potential complication of Seymour fractures, osteomyelitis is far more common with delayed presentation.
Answer 4: Superficial infection and osteomyelitis are more common infectious sequelae of Seymour fractures than septic arthritis.
Answer 5: Seymour fractures typically present with flexion deformities.