Delayed Presentation of Seymour Fractures: A Single Institution Experience and Management Recommendations

Abstract

Background: Seymour fractures in children are prone to complications without prompt and appropriate treatment. This study investigated outcomes of Seymour fractures with delayed presentations; specifically, if deep infection predisposed to operative treatment, if antibiotic administration improved fracture healing, and if oral clindamycin had fewer treatment failures than oral cephalexin. Methods: A single-institution retrospective cohort study was performed of patients with delayed Seymour fracture presentations (defined as greater than 24 hours post-injury) between 2009 and 2017. Data collected included demographics, time to presentation, infection on presentation, operative treatment, antibiotic use and duration, fracture union, and complications. Statistical testing used logistic regression and Fisher’s exact test, with results reported as P-values ( P), odds ratios (ORs), and 95% confidence intervals (CIs). Results: There were 73 patients with delayed Seymour fracture presentations, with mean age of 11.1 years (standard deviation: 2.9), with 56 (77%) males, and median time to presentation of 7 days (interquartile range: 3-17). Deep infection on presentation was a risk factor for operative intervention (OR = 34.4, P = .0001, CI, 5.5-217.2). Antibiotic administration protected against the development of a nonunion or delayed union (OR = 0.11, P = .008, CI, 0.021-0.57). Time to antibiotics did not protect against nonunion or delayed union (OR = 0.77, P = .306, CI, 0.37-1.3). Clindamycin had fewer treatment failures than cephalexin ( P = .039). Conclusions: Deep infection is a risk factor for operative treatment of Seymour fractures with delayed presentations. Clindamycin is a better antibiotic choice for Seymour fractures that present in delayed fashion.

Seymour fracture: Better do not underestimate it

“…The incidence of Seymour fractures has never been reported; only Rask et al [7] estimated its prevalence as 5.4% among distal phalanx fractures at a local institution over a 15-year period. The most common mechanisms of injury are the crushing or entrapment of the digit in a closing door or swing, or sport-related injuries, [2,[5][6][7][8][9] including the newly emerging recreational/transportation vehicle, the hoverboard, [4] among other causes. As in the rest of phalanx fractures in children, the middle finger is the most commonly involved.…”

“…The preferred antibiotic for delayed Seymour fracture treatment, described in the literature, is clindamycin instead of cephalexin, likely due to the improved osseous penetration improving its effectiveness against osteomyelitis and facilitating fracture healing. [8] Patients who underwent prompt antibiotic administration (within 24 h after injury), irrigation, debridement and fracture reduction can significantly reduce the rates of infections. [7,9] It seems to be that antibiotic administration is protective against nonunion or delayed union [8] and infection, as in our study.…”

“…[8] Patients who underwent prompt antibiotic administration (within 24 h after injury), irrigation, debridement and fracture reduction can significantly reduce the rates of infections. [7,9] It seems to be that antibiotic administration is protective against nonunion or delayed union [8] and infection, as in our study.…”

“…The preferred antibiotic for delayed Seymour fracture treatment, described in the literature, is clindamycin instead of cephalexin, likely due to the improved osseous penetration improving its effectiveness against osteomyelitis and facilitating fracture healing. [ 8 ]…”

Seymour Fracture in a Pediatric Patient: A Case Report

“…This injury typically occurs when the distal phalanx of a fully extended digit undergoes forceful flexion, or when the distal phalanx experiences a crush injury [ 3 ]. Early evaluation and treatment have been the most effective in minimizing the risk of infection and any other complications [ 4 ]. It is important to consult orthopedics or a hand specialist, especially with pediatric patients.…”