Royal Stoke University Hospital, Stoke-on-Trent, UK.
Division of Surgery and Interventional Science, Royal Free Hospital, University College London, London, UK.
Syst Rev. 2020 Jun 23;9(1):150. doi: 10.1186/s13643-020-01407-5.
Seymour fractures are open, displaced juxta-epiphyseal fractures of the distal phalanx, with an overlying nail bed laceration that occur in children and adolescents with an open physis. This fracture occurs rarely, but its potential consequences are clinically significant. Due to anatomical particulars and proximity to the growth plate, this open fracture may result in soft tissue infection and osteomyelitis, leading to growth arrest and persistent mallet deformity. At present, there is no consensus as to the optimal management of Seymour fractures. The objective of this study will be to systematically evaluate the existing evidence on the management of Seymour fractures in children and adolescents and to establish what are the most important factors pertaining to an uncomplicated recovery.
We designed and registered a study protocol for a systematic review of randomised controlled trials and observational studies. A comprehensive literature search will be conducted (from inception to present) in MEDLINE, EMBASE, CINAHL and Cochrane Library databases. Grey literature will be identified through searching Open Grey and dissertation databases using an exhaustive search strategy. All clinical studies examining the management of Seymour fractures will be included. The interventions (irrigation and debridement; prophylactic antibiotics) and their timings (early vs late) will be compared to no antibiotics and no debridement. Primary outcome measures will be the incidence of superficial and deep infection. Secondary outcomes will include other adverse events such mal-union, non-union, need for re-operation, physeal disturbance and nail dystrophy/atrophy. Two independent reviewers will screen all citations, full-text articles, and abstract data. Conflicts will be resolved through discussion. The study methodological quality (or bias) will be appraised using an appropriate tool. A narrative synthesis will be performed. If data permits, we will conduct random-effects meta-analysis where appropriate.
This review will provide evidence for the management of Seymour fractures, based on a cumulation of existing smaller studies. Due to the rarity of this fracture pattern, included studies are expected to be mainly observational and prone to bias; however, there is value in summarising the evidence to guide clinicians.
Systematic review registration: PROSPERO CRD42020153726.
Seymour 骨折是一种发生于儿童和青少年的开放性、移位性干骺端末节指骨骨折，伴有甲床撕裂伤，干骺端未闭合。这种骨折很少见，但后果严重。由于解剖学上的特殊性和靠近生长板，这种开放性骨折可能导致软组织感染和骨髓炎，导致生长停滞和持续性槌状畸形。目前，对于 Seymour 骨折的最佳治疗方法尚无共识。本研究的目的是系统评价儿童和青少年 Seymour 骨折治疗的现有证据，并确定与无并发症恢复相关的最重要因素。
我们设计并注册了一项系统评价随机对照试验和观察性研究的研究方案。将对 MEDLINE、EMBASE、CINAHL 和 Cochrane 图书馆数据库进行全面文献检索（从开始到现在）。将通过使用详尽的搜索策略在 Open Grey 和论文数据库中查找灰色文献。所有研究 Seymour 骨折治疗的临床研究都将被纳入。干预措施（冲洗和清创术；预防性抗生素）及其时机（早期与晚期）将与无抗生素和无清创术进行比较。主要结局指标是浅表和深部感染的发生率。次要结局指标包括畸形愈合、不愈合、需要再次手术、骺板干扰和指甲营养不良/萎缩等其他不良事件。两名独立的审查员将筛选所有引用、全文文章和摘要数据。通过讨论解决冲突。将使用适当的工具评估研究方法学质量（或偏倚）。将进行叙述性综合。如果数据允许，将在适当的情况下进行随机效应荟萃分析。
本综述将根据现有的较小研究的积累，为 Seymour 骨折的治疗提供证据。由于这种骨折模式很少见，预计纳入的研究主要是观察性研究，容易出现偏倚；然而，总结证据以指导临床医生是有价值的。
系统评价注册：PROSPERO CRD42020153726。
