The Ohio State University Wexner Medical Center, Columbus, USA.
Nationwide Children's Hospital, Columbus, OH, USA.
Hand (N Y). 2021 Sep;16(5):686-693. doi: 10.1177/1558944719878846. Epub 2019 Oct 9.
Seymour fractures in children are prone to complications without prompt and appropriate treatment. This study investigated outcomes of Seymour fractures with delayed presentations; specifically, if deep infection predisposed to operative treatment, if antibiotic administration improved fracture healing, and if oral clindamycin had fewer treatment failures than oral cephalexin. A single-institution retrospective cohort study was performed of patients with delayed Seymour fracture presentations (defined as greater than 24 hours post-injury) between 2009 and 2017. Data collected included demographics, time to presentation, infection on presentation, operative treatment, antibiotic use and duration, fracture union, and complications. Statistical testing used logistic regression and Fisher's exact test, with results reported as values (), odds ratios (ORs), and 95% confidence intervals (CIs). There were 73 patients with delayed Seymour fracture presentations, with mean age of 11.1 years (standard deviation: 2.9), with 56 (77%) males, and median time to presentation of 7 days (interquartile range: 3-17). Deep infection on presentation was a risk factor for operative intervention (OR = 34.4, = .0001, CI, 5.5-217.2). Antibiotic administration protected against the development of a nonunion or delayed union (OR = 0.11, = .008, CI, 0.021-0.57). Time to antibiotics did not protect against nonunion or delayed union (OR = 0.77, = .306, CI, 0.37-1.3). Clindamycin had fewer treatment failures than cephalexin ( = .039). Deep infection is a risk factor for operative treatment of Seymour fractures with delayed presentations. Clindamycin is a better antibiotic choice for Seymour fractures that present in delayed fashion.
儿童 Seymour 骨折如果不及时、恰当治疗，容易出现并发症。本研究探讨了延迟就诊 Seymour 骨折的结果；具体而言，如果深部感染会导致手术治疗，抗生素的使用是否会促进骨折愈合，以及口服克林霉素的治疗失败率是否低于口服头孢氨苄。对 2009 年至 2017 年期间延迟 Seymour 骨折就诊（定义为受伤后超过 24 小时）的患者进行了单机构回顾性队列研究。收集的数据包括人口统计学资料、就诊时间、就诊时感染情况、手术治疗、抗生素使用和持续时间、骨折愈合和并发症。统计检验采用逻辑回归和 Fisher 精确检验，结果以值（）、比值比（OR）和 95%置信区间（CI）表示。有 73 例 Seymour 骨折延迟就诊，平均年龄 11.1 岁（标准差：2.9），56 例（77%）为男性，中位数就诊时间为 7 天（四分位间距：3-17）。就诊时深部感染是手术干预的危险因素（OR = 34.4， =.0001，CI，5.5-217.2）。抗生素的使用可以预防非愈合或延迟愈合（OR = 0.11， =.008，CI，0.021-0.57）。使用抗生素的时间并不能预防非愈合或延迟愈合（OR = 0.77， =.306，CI，0.37-1.3）。克林霉素的治疗失败率低于头孢氨苄（ =.039）。深部感染是延迟就诊 Seymour 骨折手术治疗的危险因素。克林霉素是治疗延迟就诊 Seymour 骨折的更好选择。
