The High Risk of Infection with Delayed Treatment of Open Seymour Fractures: Salter-Harris I/II or Juxta-epiphyseal Fractures of the Distal Phalanx with Associated Nailbed Laceration

Bryan A. Reyes, Christine A. Ho

Research output: Contribution to journalArticlepeer-review

29 Scopus citations

Abstract

Background: To describe treatment methods and complication rates of all open Seymour fractures (Salter-Harris I/II or juxta-epiphyseal fractures of the distal phalanx of the hand with associated nailbed laceration) treated at or referred to a pediatric level 1 trauma center over a 10-year time period. We hypothesized that delayed treatment of Seymour fractures results in higher infectious complication rates. Methods: We identified all patients treated for open Seymour fractures at the orthopaedic hand clinic at our level 1 pediatric trauma center between August 2002 and December 2012. All charts were reviewed retrospectively. Patients were divided into groups based on timing and completeness of treatment. "Appropriate" treatment was defined as irrigation and debridement, fracture reduction, and antibiotic administration. "Partial" treatment was defined as any type of incomplete treatment; "Acute" treatment was defined as management within 24 hours of the injury; and "Delayed" as having received treatment after 24 hours from the time of injury. Statistical comparisons were performed using the Fisher exact test. Results: A total of 34 patients treated for 35 Seymour fractures met the inclusion criteria. In total, 31% (11/35) received acute, appropriate treatment, 37% (13/35) received acute, partial treatment, and 31% (11/35) received delayed treatment. There were 7 infectious complications: 2 superficial and 5 osteomyelitis. No infections occurred in the acutely, appropriately treated group (infection rate 0%, 0/11), 2 occurred in the acutely, partially treated group (15%, 2/13), and 5 occurred in the delayed treatment group (45%, 5/11). Conclusions: The timing and quality of treatment of open Seymour fractures significantly influences infection rates. This study highlights the importance of timely and appropriate treatment of this seemingly innocuous fracture. Level of Evidence: Level III - retrospective study, therapeutic.

Original languageEnglish (US)
Pages (from-to)247-253
Number of pages7
JournalJournal of Pediatric Orthopaedics
Volume37
Issue number4
DOIs
StatePublished - 2017

Keywords

  • infection
  • osteomyelitis
  • Seymour fracture

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Orthopedics and Sports Medicine

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