Krusche-Mandl Irena, Köttstorfer Julia, Thalhammer Gerhild, Aldrian Silke, Erhart Jochen, Platzer Patrick
Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria.
J Hand Surg Am. 2013 Feb;38(2):258-64. doi: 10.1016/j.jhsa.2012.11.015.
To analyze the management of Seymour fractures (juxta-epiphyseal fractures of the terminal phalanx of the finger in conjunction with flexion deformity at the fracture site, laceration of the nail bed, and frequently ungual subluxation) and to determine clinical and radiographic results following operative or conservative treatment.
Clinical and radiological results of 24 skeletally immature patients (7 girls and 17 boys; mean age, 8.5 y) with Seymour fractures were evaluated. Assessment after a mean follow-up of 10 years (range, 1-18 y) included the range of motion, the modified Kapandji index, growth disturbance of the effected digit and nail, pain according to the visual analog scale, and patients' satisfaction.
Nine patients received nonoperative treatment. Operative management included debridement, open reduction, and fixation in 9. Owing to instability, an additional K-wire passing across the distal interphalangeal joint was used in 5. In 1 patient, the nail was removed. All surgically treated patients received a splint and perioperative cephalosporin. Twenty-three patients out of 24 gained full motion (mean, 80°; range, 65°-90°). The average modified Kapandji index was 5.0 for extension and 4.8 for flexion. Long-term minor growth disturbance of the distal phalanx (seen on radiographs at high amplification only) and nail were noted in 5 patients, and solitary nail dystrophies were observed in 6 patients. Nine of the 11 nail growth irregularities were not a relevant cosmetic problem for the patients. Patients' satisfaction assessment revealed a good clinical outcome. There was neither flexion deformity nor infection in our collective. At the 1-year follow-up examination, the average visual analog score was 0.6 (range, 0-2).
According to the literature, the Seymour fracture is an often-underestimated injury, and open cases are prone to infection. Evaluation of the outcome in our collective demonstrated good results with the treatment approaches described.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
分析西摩骨折（手指末节指骨骨骺旁骨折，伴有骨折部位的屈曲畸形、甲床裂伤以及常见的指甲半脱位）的治疗方法，并确定手术或保守治疗后的临床及影像学结果。
对24例骨骼未成熟的西摩骨折患者（7例女性，17例男性；平均年龄8.5岁）的临床和影像学结果进行评估。平均随访10年（范围1 - 18年）后的评估内容包括活动范围、改良的卡潘迪指数、患指和指甲的生长紊乱情况、根据视觉模拟量表评估的疼痛程度以及患者满意度。
9例患者接受非手术治疗。手术治疗包括清创、切开复位及内固定，共9例。由于骨折不稳定，5例患者额外使用了一根穿过远侧指间关节的克氏针。1例患者拔除了指甲。所有接受手术治疗的患者均使用了夹板并在围手术期使用头孢菌素。24例患者中有23例获得了完全活动度（平均80°；范围65° - 90°）。平均改良卡潘迪指数为：伸展时5.0，屈曲时4.8。5例患者在X线片高倍放大下可见末节指骨长期存在轻微生长紊乱，6例患者观察到孤立性指甲营养不良情况。11例指甲生长不规则情况中，有9例对患者来说并非严重的美容问题。患者满意度评估显示临床结果良好。我们的病例组中未出现屈曲畸形及感染情况。在1年的随访检查中，平均视觉模拟评分为0.6（范围0 - 2）。
根据文献报道，西摩骨折是一种常被低估的损伤，开放性病例易发生感染。我们病例组的治疗结果表明，所描述的治疗方法效果良好。
研究类型/证据水平：治疗性IV级。
