Lin James S, Popp James E, Balch Samora Julie
The Ohio State University Wexner Medical Center.
Nationwide Children's Hospital, Columbus, OH.
J Pediatr Orthop. 2019 Jan;39(1):e23-e27. doi: 10.1097/BPO.0000000000001275.
Seymour fractures are distal phalanx fractures in children with a juxta-epiphyseal pattern. The purpose of our study was to investigate the treatments, outcomes, operative ;indications, and antibiotic choice for acute Seymour fractures (presenting within 24 h of injury), to better define optimal management. We hypothesized that: (1) cephalexin provides adequate antibiotic coverage for acute Seymour fractures; (2) most injuries will achieve good outcomes with management in the emergency department (ED) alone; and (3) indication for operative intervention is unsuccessful or unstable reduction in the ED.
We performed a retrospective study of patients under 18 years old treated at a large pediatric hospital from 2009 to 2017 for an acute Seymour fracture. Study outcomes included management and antibiotic type, infection, fracture healing, malunion, physeal disturbance, nail dystrophy, antibiotic failure, and need for unplanned operative intervention.
Mean age of patients was 10 years, with 43 males and 22 females sustaining 65 Seymour fractures. Fifty-eight cases (89%) were initially managed in the emergency department. Seven cases were initially managed with an operative intervention that included I&D, open reduction, and K-wire fixation. The most commonly cited surgical indication was unsuccessful closed reduction. Four patients initially managed in the ED required an unplanned operation, usually because of fracture redisplacement. Complications were rare, with superficial infections being most common.
Most acute Seymour fractures can be successfully managed in the emergency department if stable reduction is achieved.
Level IV, therapeutic.
西摩骨折是儿童近骨骺型的指骨远端骨折。本研究的目的是调查急性西摩骨折（伤后24小时内就诊）的治疗方法、结果、手术指征和抗生素选择，以更好地确定最佳治疗方案。我们假设：（1）头孢氨苄可为急性西摩骨折提供足够的抗生素覆盖；（2）大多数损伤仅在急诊科处理就能取得良好结果；（3）手术干预的指征是在急诊科复位不成功或复位不稳定。
我们对2009年至2017年在一家大型儿科医院接受治疗的18岁以下急性西摩骨折患者进行了回顾性研究。研究结果包括治疗方法和抗生素类型、感染、骨折愈合、畸形愈合、骨骺损伤、指甲营养不良、抗生素治疗失败以及非计划手术干预的必要性。
患者平均年龄为10岁，43名男性和22名女性共发生65例西摩骨折。58例（89%）最初在急诊科处理。7例最初采用包括切开引流、切开复位和克氏针固定在内的手术干预。最常见的手术指征是闭合复位不成功。最初在急诊科处理的4例患者需要进行非计划手术，通常是因为骨折再移位。并发症很少见，最常见的是浅表感染。
如果能实现稳定复位，大多数急性西摩骨折可在急诊科成功处理。
四级，治疗性。
