The silent threat under the nail: Evaluation of Seymour fractures in pediatric patients.

Abstract

Objectives: This study aims to examine the diagnosis, treatment methods, and outcomes of Seymour fractures and to address diagnostic challenges in these fractures.

Patients and methods: Between January 2020 and November 2023, a total of 28 pediatric patients (18 males, 11 females; mean age: 6.8±4.5 years; range, 1 to 15 years) who presented with Seymour fractures within 24 h of injury were retrospectively analyzed. Patients were treated either conservatively in the emergency department or surgically in the operating room if closed reduction was unsuccessful. All patients received intravenous antibiotics within the first 24 h, followed by oral antibiotics after discharge. Infection rates, physeal arrest, and nail dystrophy were evaluated during follow-up.

Results: The mean follow-up was 16.6±6.6 (range, 12 to 32) months. There was no statistically significant difference in the affected side (right/left) and fingers (p=0.43 and p>0.05, respectively). The complication rate was significantly higher in surgically treated patients compared to those treated conservatively (p=0.02 and p<0.05, respectively). Evaluation of patients based on finger mobility showed no motion loss in the conservatively treated group at the final follow-up. In the surgically treated group, however, motion restrictions were noted in only two patients. Early antibiotic administration within 24 h significantly reduced infection rates, with only 3.5% (n=1) of patients developing osteomyelitis.

Conclusion: Stable Seymour fractures can be treated conservatively in the emergency setting, while complex cases may require surgical intervention in the operating room. Early antibiotic use is essential in minimizing infection risk. Antibiotherapy within the first 24 h after injury is an effective way to prevent infection.