From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University and Medical College, Taoyuan City, Taiwan.
Ann Plast Surg. 2022 Oct 1;89(4):380-384. doi: 10.1097/SAP.0000000000003261. Epub 2022 Jun 11.
We aimed to suggest treatment strategies for Seymour fractures (SFs) with varying clinical manifestations, based on the retrospective outcomes of patients seen at our institute.
Between March 2000 and December 2019, a total of 26 SF patients were categorized into 3 groups: acute typical SF (category 1; open fracture/exposed germinal matrix and physis), acute injuries but delayed presentation (category 2; presented to our institute more than 24 hours after the injury with misdiagnosis as simple nail injuries), and direct crush injuries (category 3; the most severe injury type, characterized by nail loss, nail bed lacerations, or maceration of the germinal matrix). In category 1, reduction was maintained using K-wire fixation without nail plate sutures. In 2, massive irrigation/debridement was followed by reduction and nail plate suturing without K-wire fixation. Finally, in 3, nail bed repair, reinsertion of the extracted nail plate after creating a penetration hole for drainage, K-wire fixation, and nail plate suturing were sequentially performed.
The mean age of the patients was 8.92 years. At the final follow-up, the mean dorsal angulation was 1.73 degrees, and the length ratio was 97.88%; no significant differences were observed compared with the contralateral normal side ( P = 0.498 and P = 0.341, respectively). The final visual analog scale pain score; the Disabilities of the Arm, Shoulder, and Hand score; and the active range of motion ratio were 0.50, 1.52, and 96.92%, respectively. There were no significant complications requiring revision surgery. Although the overall outcomes were satisfactory, category 3 patients had slightly worse visual analog scale pain scores; Disabilities of the Arm, Shoulder, and Hand scores; and range of motion compared with those in the other categories ( P = 0.003, P = 0.002, and P < 0.001, respectively).
Satisfactory clinical outcomes were obtained by applying different surgical treatments to the different SF categories. We have suggested appropriate treatment strategies for acute SF varying in severity.
我们旨在根据本研究所见患者的回顾性结果，为不同临床表现的 Seymour 骨折（SF）提出治疗策略。
在 2000 年 3 月至 2019 年 12 月期间，共将 26 例 SF 患者分为 3 组：急性典型 SF（第 1 类；开放性骨折/暴露的生发基质和骨骺）、急性损伤但延迟表现（第 2 类；受伤后超过 24 小时就诊，误诊为单纯钉伤）和直接压伤（第 3 类；最严重的损伤类型，表现为指甲缺失、甲床撕裂或生发基质糜烂）。在第 1 类中，不使用钉板缝线通过 K 线固定维持复位。在第 2 类中，大量冲洗清创后，进行复位和钉板缝合，不使用 K 线固定。最后，在第 3 类中，依次进行甲床修复、在为引流创建穿透孔后重新插入拔出的钉板、K 线固定和钉板缝合。
患者的平均年龄为 8.92 岁。最终随访时，背侧成角平均为 1.73 度，长度比为 97.88%；与对侧正常侧相比，无显著差异（分别为 P=0.498 和 P=0.341）。最终视觉模拟评分疼痛量表、上肢功能障碍评分和主动活动范围比分别为 0.50、1.52 和 96.92%。无需要再次手术的重大并发症。虽然总体结果令人满意，但第 3 类患者的视觉模拟评分疼痛量表、上肢功能障碍评分和活动范围略差于其他类别（分别为 P=0.003、P=0.002 和 P<0.001）。
对不同严重程度的急性 SF 应用不同的手术治疗，获得了满意的临床结果。我们已经为不同严重程度的急性 SF 提出了适当的治疗策略。
