American Association for Hand Surgery
Theme: Beyond Innovation

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Treatment of Acute Seymour Fractures
James S Lin, MD1; James E Popp, MD2; Julie Balch Samora, MD, PhD2
1The Ohio State University, Columbus, OH, 2Nationwide Children's Hospital, Columbus, OH

Abstract
Purpose: The recommended management of pediatric Seymour fractures has evolved in the last half century since the original description. We sought to investigate the treatments and outcomes of these cases at our institution to provide guidance on optimal management.
Methods: We performed a retrospective study of patients under 18 years of age treated at a large tertiary pediatric hospital from 2009 to 2017 diagnosed with a Seymour fracture that presented acutely (within 24 hours of injury). We aimed to investigate interventions performed, location of treatment (emergency department vs operating room), operative indications, antibiotic selection, and clinical outcomes (including evidence of fracture healing, malunion, physeal disturbance, nail dystrophy, antibiotic side effects, and unplanned trips to the operating room to address shortcomings of initial treatment).
Results: The mean age of included patients was 10 years (range 116 years old, SD 3) with 43 males (66%) and 22 females (34%) sustaining a total of 65 Seymour fractures. 58 (89%) cases were initially managed nonsurgically, with 63% of patients receiving thorough irrigation & debridement in the emergency department. Seven (11%) cases were initially managed with an operative intervention that included formal irrigation & debridement, open reduction, and K-wire fixation (Table 1). The most commonly cited surgical indication was unsuccessful or unstable closed reduction. Four (7%) patients initially managed nonsurgically did require an unplanned operation, usually due to re-displacement of the fracture (Table 2). 82% of patients received antibiotics, with cephalexin being used in 74% of all patients (Table 3). Cephalexin treatment failed in 3 cases (6% of cases using cephalexin). Complications of injury were rare, with superficial infections being most common.
Conclusion: Most acute Seymour fractures can be successfully managed in the emergency department if a stable reduction can be achieved. Given its overall efficacy and tolerance, a course of oral cephalexin is also recommended following acute Seymour fractures.
Level of evidence: IV, therapeutic
Keywords: pediatric, open fracture, Seymour fracture, infection




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