Updated: 9/25/2018

Seymour Fracture

Topic
Review Topic
0
0
Questions
1
0
0
Evidence
2
0
0
Videos
2
Cases
1
https://upload.orthobullets.com/topic/6000/images/smimages.jpg
https://upload.orthobullets.com/topic/6000/images/seymourap.jpg
 Introduction
  • Displaced distal phalangeal physeal fracture with an associated nailbed injury
  • Epidemiology
    • incidence
      • 20% to 30% of phalangeal fractures involve the physis in children
    • body location
      • middle finger injury is most common
      • type of the distal phalangeal physeal fracture:
        • metaphyseal fractures 1 to 2 mm distal to the epiphyseal plate
        • Salter-Harris I fractures
        • Salter-Harris II fractures
      • type of nailbed injury:
        • nailbed laceration
        • nail plate subluxation
        • interposition of soft tissue at fracture site (usually germinal matrix)
  • Pathophysiology
    • mechanism of injury
      • direct trauma or crush injury (e.g. caught in door, heavy object or sport)
    • pathoanatomy
      • similar mechanism to mallet finger in adults
      • injury causes flexed posturing of the distal phalanx
      • deformity results from an imbalance between the flexor and the extensor tendons at the level of the fracture
      • imbalance occurs due to different insertion sites of flexor and extensor tendons
        • extensor tendon inserts into the epiphysis of the distal phalanx
        • flexor tendon inserts into metaphysis of the distal phalanx
      • widened physis likely to have interposed tissue in the fracture site 
  • Prognosis
    • operative intervention is warranted to ensure that there is no interposed tissue in the fracture site
    • failure to recognize injury may result in:
      • nailplate deformity
      • physeal arrest
      • chronic osteomyelitis
 Presentation
  • Physical exam
    • apparent mallet deformity
    • echymosis and swelling
    • nail plate lying superficial to the eponychial fold
 Imaging
  • Radiographs
    • recommended views
      • PA
        • may appear normal
      • lateral
    • findings
      • widened physis or displacement between epiphysis/metaphysis
      • flexion deformity at fracture site 
        • seen on lateral view
Differential Diagnosis
  • Mallet finger
    • pediatric mallet finger is usually osseous avulsion (SH III and SH IV)
    • mallet finger fracture line enters DIPJ, while Seymour fracture line traverses physis (does not enter DIPJ)
 Treatment
  • Nonoperative
    • closed reduction and splinting
      • indications
        • minimally displaced, closed fracture
        • no interposition of soft tissue at fracture site
  • Operative
    • closed reduction and pinning across DIPJ 
      • indications
        • displaced, closed fracture
        • no interposition of soft tissue at fracture site
    • antibiotics, open reduction and pinning across DIPJ, nailbed repair
      • open management has fewer complications than closed management
      • indications
        • open fracture
      • technique
        • hyperflexion of the digit will permit removal of the interposed soft tissue from the fracture site
        • thorough irrigation and debridement
        • anatomical reduction and retrograde k-wire fixation crossing the fracture site and DIP joint
        • nailbed injury repair
Complications
  • Nail dystrophy
  • Growth disturbance of the distal phalanx and nail
  • Secondary fracture displacement 
  • Chronic osteomyelitis (failure to treat as open fracture)
  • Flexion deformity
 

Please rate topic.

Average 4.3 of 17 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Questions (1)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
ARTICLES (2)
VIDEOS (2)
CASES (1)
Topic COMMENTS (0)
Private Note