Seymour Fracture

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Evan Watts MD

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 Summary
o Seymour Fractures are displaced distal phalangeal physeal fractures with an associated nailbed
injury.
o Diagnosis is made clinically with the presence of nail plate lying superficial to the eponychial
fold and radiographs potentially showing widened physis or displacement between the epiphysis
and metaphysis.
o Treatment is usually antibiotics, open reduction and pinning across DIPJ with nailbed repair.
 Epidemiology
o Incidence
 20% to 30% of phalangeal fractures involve the physis in children
o Anatomic location
 middle finger injury is most common
 type of the distal phalangeal physeal fracture:
 metaphyseal fractures 1 to 2 mm distal to the epiphyseal plate
 Salter-Harris I fractures
 Salter-Harris II fractures
 type of nailbed injury:
 nailbed laceration
 nail plate subluxation
 interposition of soft tissue at fracture site (usually germinal matrix)
 Etiology
o Pathophysiology
 mechanism of injury
 direct trauma or crush injury (e.g. caught in door, heavy object or sport)
 pathoanatomy
 similar mechanism to mallet finger in adults
 injury causes flexed posturing of the distal phalanx
 deformity results from an imbalance between the flexor and the extensor tendons at the level of
the fracture
 imbalance occurs due to different insertion sites of flexor and extensor tendons
 extensor tendon inserts into the epiphysis of the distal phalanx
 flexor tendon inserts into metaphysis of the distal phalanx
 widened physis likely to have interposed tissue in the fracture site
 Presentation
o Physical exam
 apparent mallet deformity
 echymosis and swelling
 nail plate lying superficial to the eponychial fold
 Imaging
o Radiographs
 recommended views
 PA
 may appear normal
 lateral
 findings
 widened physis or displacement between epiphysis/metaphysis
 flexion deformity at fracture site
 seen on lateral view
 Differential
o Mallet finger
 pediatric mallet finger is usually osseous avulsion (SH III and SH IV)
 mallet finger fracture line enters DIPJ, while Seymour fracture line traverses physis (does
not enter DIPJ)
 Treatment
o Nonoperative
 closed reduction and splinting
 indications
 minimally displaced, closed fracture
 no interposition of soft tissue at fracture site
o Operative
 closed reduction and pinning across DIPJ
 indications
 displaced, closed fracture
 no interposition of soft tissue at fracture site
 open reduction and pinning across DIPJ, nailbed repair
 open management has fewer complications than closed management
 indications
 open fracture
 technique
 hyperflexion of the digit will permit removal of the interposed soft tissue from the fracture site
 thorough irrigation and debridement
 anatomical reduction and retrograde k-wire fixation crossing the fracture site and DIP joint
 nailbed injury repair
 Complications
o Nail dystrophy
o Growth disturbance of the distal phalanx and nail
o Secondary fracture displacement
o Chronic osteomyelitis (failure to treat as open fracture)
o Flexion deformity
 Prognosis
o Operative intervention is warranted to ensure that there is no interposed tissue in the fracture site
o Failure to recognize injury may result in:
 nailplate deformity
 physeal arrest
 chronic osteomyelitis