Treatment Strategies for Acute Seymour Fractures in Children and Adolescents: Including Crushed Open Fractures. Issue 4 (11th June 2022)

• Record Type: Journal Article
• Authors: Cha, Soo Min; Lin, Yu-Te
• Is Part Of: Annals of plastic surgery. Volume 89:Issue 4(2022)
• Page Start: 380
• Page End: 384
• Publication Date: 2022-06-11
• Subjects: Seymour fracture -- epiphyseal injury -- physis -- K-wire; Surgery, Plastic -- Periodicals; 617.95205
• DOI: 10.1097/SAP.0000000000003261
• Languages: English
• ISSNs: 0148-7043

Abstract

Abstract : Purpose: We aimed to suggest treatment strategies for Seymour fractures (SFs) with varying clinical manifestations, based on the retrospective outcomes of patients seen at our institute. Methods: Between March 2000 and December 2019, a total of 26 SF patients were categorized into 3 groups: acute typical SF (category 1; open fracture/exposed germinal matrix and physis), acute injuries but delayed presentation (category 2; presented to our institute more than 24 hours after the injury with misdiagnosis as simple nail injuries), and direct crush injuries (category 3; the most severe injury type, characterized by nail loss, nail bed lacerations, or maceration of the germinal matrix). In category 1, reduction was maintained using K-wire fixation without nail plate sutures. In 2, massive irrigation/debridement was followed by reduction and nail plate suturing without K-wire fixation. Finally, in 3, nail bed repair, reinsertion of the extracted nail plate after creating a penetration hole for drainage, K-wire fixation, and nail plate suturing were sequentially performed. Results: The mean age of the patients was 8.92 years. At the final follow-up, the mean dorsal angulation was 1.73 degrees, and the length ratio was 97.88%; no significant differences were observed compared with the contralateral normal side ( P = 0.498 and P = 0.341, respectively). The final visual analog scale pain score; the Disabilities of the Arm, Shoulder, and Hand score; and the active range of motion ratio were 0.50, 1.52, and 96.92%, respectively. There were no significant complications requiring revision surgery. Although the overall outcomes were satisfactory, category 3 patients had slightly worse visual analog scale pain scores; Disabilities of the Arm, Shoulder, and Hand scores; and range of motion compared with those in the other categories ( P = 0.003, P = 0.002, and P < 0.001, respectively). Conclusions: Satisfactory clinical outcomes were obtained by applying different surgical treatments to the different SF categories. We have suggested appropriate treatment strategies for acute SF varying in severity.