Department of Plastic and Reconstructive Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Trust, Edgbaston, United Kingdom.
Department of Plastic and Reconstructive Surgery, Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, Merseyside, United Kingdom.
J Hand Surg Am. 2022 Dec;47(12):1223.e1-1223.e20. doi: 10.1016/j.jhsa.2021.08.022. Epub 2021 Nov 19.
Seymour fractures are injuries with a potentially high risk of infection and osteomyelitis. The optimal management of this pediatric open fracture is unknown. We performed a systematic review and meta-analysis to summarize the best evidence for these fractures and determine their optional management based on primary clinical studies.
A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review and meta-analysis was performed. A comprehensive search strategy was applied to the MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, and gray literature databases (from May 1966 to April 15, 2020). Studies describing patients under the age of 18 years with Seymour fractures were included. Treatment was grouped based on debridement and antibiotic status as well as the timing of these interventions. The primary outcome was infection. The secondary outcomes included malunion, physeal disturbance, and nail dystrophy.
The searches helped identify 56 records, of which 10 nonrandomized studies met our inclusion criteria, comprising 352 patients and 355 fractures. Early (<48 hours) debridement was associated with significantly less risk of infection (risk ratio [RR] = 0.28 [95% CI, 0.12-0.64]) and malunion (RR = 0.25 [95% CI, 0.07-0.99]). Prophylactic (<24 hours) antibiotics significantly reduced the risk of infection (RR = 0.21 [95% CI, 0.10-0.43]). In addition, prophylactic antibiotics and debridement were associated with a 70% reduction in the risk of infection (RR = 0.30 [95% CI, 0.11-0.83]). Over one-third of patients with delayed presentation (median 8.5 days) were infected at presentation.
The high-risk nature of Seymour fractures may be mitigated by prompt recognition and early, basic interventions, which can usually be performed in any setting.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
西摩氏骨折是一种具有较高感染和骨髓炎风险的损伤。对于这种小儿开放性骨折，最佳的治疗方法尚不清楚。我们进行了一项系统回顾和荟萃分析，以总结这些骨折的最佳证据，并根据主要临床研究确定其可选治疗方法。
进行了一项符合系统评价和荟萃分析首选报告项目的系统回顾和荟萃分析。采用综合检索策略对 MEDLINE、EMBASE、护理学及相关健康文献累积索引、Cochrane 图书馆和灰色文献数据库（1966 年 5 月至 2020 年 4 月 15 日）进行了检索。纳入描述年龄在 18 岁以下患有西摩氏骨折的患者的研究。治疗方法根据清创和抗生素状况以及这些干预措施的时机进行分组。主要结局是感染。次要结局包括畸形愈合、骺板干扰和甲营养不良。
检索结果共确定了 56 条记录，其中 10 项非随机研究符合纳入标准，共纳入 352 例患者和 355 处骨折。早期（<48 小时）清创与感染风险显著降低相关（风险比 [RR] = 0.28 [95% CI，0.12-0.64]）和畸形愈合（RR = 0.25 [95% CI，0.07-0.99]）。预防性（<24 小时）抗生素显著降低感染风险（RR = 0.21 [95% CI，0.10-0.43]）。此外，预防性抗生素和清创术可将感染风险降低 70%（RR = 0.30 [95% CI，0.11-0.83]）。超过三分之一延迟就诊（中位数 8.5 天）的患者在就诊时即已感染。
及时识别和早期进行基本干预可以降低西摩氏骨折的高风险，而这些干预通常可在任何环境下进行。
研究类型/证据水平：治疗性 IV 级。
