Reyes Bryan A, Ho Christine A
*Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center †Children's Medical Center of Dallas ‡Texas Scottish Rite Hospital for Children, Dallas, TX.
J Pediatr Orthop. 2017 Jun;37(4):247-253. doi: 10.1097/BPO.0000000000000638.
To describe treatment methods and complication rates of all open Seymour fractures (Salter-Harris I/II or juxta-epiphyseal fractures of the distal phalanx of the hand with associated nailbed laceration) treated at or referred to a pediatric level 1 trauma center over a 10-year time period. We hypothesized that delayed treatment of Seymour fractures results in higher infectious complication rates.
We identified all patients treated for open Seymour fractures at the orthopaedic hand clinic at our level 1 pediatric trauma center between August 2002 and December 2012. All charts were reviewed retrospectively. Patients were divided into groups based on timing and completeness of treatment. "Appropriate" treatment was defined as irrigation and debridement, fracture reduction, and antibiotic administration. "Partial" treatment was defined as any type of incomplete treatment; "Acute" treatment was defined as management within 24 hours of the injury; and "Delayed" as having received treatment after 24 hours from the time of injury. Statistical comparisons were performed using the Fisher exact test.
A total of 34 patients treated for 35 Seymour fractures met the inclusion criteria. In total, 31% (11/35) received acute, appropriate treatment, 37% (13/35) received acute, partial treatment, and 31% (11/35) received delayed treatment. There were 7 infectious complications: 2 superficial and 5 osteomyelitis. No infections occurred in the acutely, appropriately treated group (infection rate 0%, 0/11), 2 occurred in the acutely, partially treated group (15%, 2/13), and 5 occurred in the delayed treatment group (45%, 5/11).
The timing and quality of treatment of open Seymour fractures significantly influences infection rates. This study highlights the importance of timely and appropriate treatment of this seemingly innocuous fracture.
Level III-retrospective study, therapeutic.
描述在一家一级儿科创伤中心接受治疗或转诊的所有开放性西摩骨折（Salter-Harris I/II型或手部远节指骨骨骺旁骨折伴甲床裂伤）的治疗方法及并发症发生率。我们假设西摩骨折延迟治疗会导致更高的感染并发症发生率。
我们确定了2002年8月至2012年12月期间在我们一级儿科创伤中心的骨科手部诊所接受开放性西摩骨折治疗的所有患者。所有病历均进行回顾性审查。根据治疗时间和完整性将患者分组。“适当”治疗定义为冲洗清创、骨折复位及抗生素给药。“部分”治疗定义为任何类型的不完全治疗；“急性”治疗定义为在受伤后24小时内进行处理；“延迟”治疗定义为在受伤24小时后接受治疗。采用Fisher精确检验进行统计学比较。
共有34例患者因35处西摩骨折接受治疗并符合纳入标准。总体而言，31%（11/35）接受了急性、适当治疗，37%（13/35）接受了急性、部分治疗，31%（11/35）接受了延迟治疗。发生了7例感染并发症：2例表浅感染和5例骨髓炎。急性、适当治疗组未发生感染（感染率0%，0/11），急性、部分治疗组发生2例（15%，2/13），延迟治疗组发生5例（45%，5/11）。
开放性西摩骨折的治疗时间和质量显著影响感染率。本研究强调了及时、适当治疗这种看似无害骨折的重要性。
III级——回顾性研究，治疗性。
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