Khairnar Tarang S, Patwardhan Sandeep A, Sodhai Vivek M, Shyam Ashok K, Sancheti Parag K
Department of Paediatric Orthopaedics, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
Department of Clinical Research, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
J Orthop Case Rep. 2021 May;11(5):45-47. doi: 10.13107/jocr.2021.v11.i05.2200.
A nail bed injury concomitant with an underlying physeal injury of the distal phalanx is termed as "Seymour's fracture." These are seemingly innocuous injuries commonly misdiagnosed and are subsequently under-treated. These injuries demand treatment like an open fracture to prevent complications such as infection, growth arrest, and nail dystrophies.
A 13-year-old boy suffered Seymour's fracture of the left ring finger distal phalanx after a direct injury from a dodge ball. The fracture was treated with thorough debridement with normal saline, physeal injury reduction through the wound, and fixation with k-wire passed through the tip of the ring finger, metaphysic, physis, and the tip of the k-wire ending in the epiphysis of the distal phalanx. The nail bed was sutured with 3-0 monofilament absorbable sutures. The fracture healed at 3 months and a 1-year follow-up showed a completely formed nail without any deformity.
Excellent outcome was observed with debridement of the wound, nail bed repair, and fixation with k-wire in our case. Nail bed injuries in children should be treated with a high index of suspicion for Seymour's fracture as it necessitates treatment like that of an open fracture to avoid complications.
甲床损伤合并远节指骨潜在的骨骺损伤被称为“西摩骨折”。这些损伤看似无害，却常被误诊，随后治疗不足。此类损伤需要像开放性骨折一样进行治疗，以预防感染、生长停滞和指甲营养不良等并发症。
一名13岁男孩在被躲避球直接击中后，左手环指远节指骨发生西摩骨折。通过用生理盐水彻底清创、经伤口复位骨骺损伤，并通过将克氏针穿过环指指尖、干骺端、骨骺及克氏针末端位于远节指骨骨骺内进行固定来治疗骨折。甲床用3-0单丝可吸收缝线缝合。骨折在3个月时愈合，1年随访显示指甲完全形成，无任何畸形。
在我们的病例中，通过伤口清创、甲床修复和克氏针固定观察到了良好的结果。儿童甲床损伤应高度怀疑西摩骨折，因为它需要像开放性骨折一样进行治疗以避免并发症。
