Seymour's Fracture of the Base of the Distal Phalanx in a Child.

Kim, Cheol Hann; Tark, Min Sung

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Case Report

Journal of the Korean Society of Plastic and Reconstructive Surgeons 2006;33(6):776-779.
Published online November 1, 2006.

Seymour's Fracture of the Base of the Distal Phalanx in a Child.

Cheol Hann Kim, Min Sung Tark

Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Seoul, Korea. kchann@hanmail.net

Abstract

PURPOSE
Prior to closure of the epiphysis of the distal phalanx, fracture usually occurs through the growth plate, Salter-Harris type I or II, or through the juxtaepiphyseal region 1 to 2 mm distal to the growth plate. The terminal tendon of extensor inserts into the epiphysis only, while insertion site of the flexor digitorum profundus spans both the epiphysis and metaphysis. Because of the difference between these tendon insertions, this injury mimics a mallet deformity. But, this type of injury does not involve a tear or avulsion of the extensor, unlike mallet finger of adults. Seymour was the first to describe this type of injury in children and called after his name, Seymour's fracture. This fracture is prone to infection or remain the residual deformity unless adequate treatment. METHODS: We report a case of Seymour's fracture. A 9-year-old boy presented a laceration of the nail matrix, with the nail lies degloved from the nail fold on the right middle finger gotten from an impact against a door. An X-ray examination showed the fracture line lying 1 mm distal to the growth plate. The injury was treated with debridement and the fracture was reduced by applying hyperextension force. Under the C-arm, a single 0.7 mm K-wire was used to immobilize the distal interphalangeal joint. Intravenous antibiotics were applied for 5 days after surgery.
RESULTS
The K-wire was removed in the 3rd week. No infection or significant deformity was found until follow-up of 12 months.
CONCLUSION
Seymour's fracture may be at first classically mallet deformity by its appearance. But it is anatomically different and more problematic injury. If it isn't corrected at the time of injury, derangement of the extensor mechanism, and growth deformity of the distal phalanx may occur. The fracture site should be debrided, removed of any interposed soft tissue, and the patient should be given appropriate antibiotics. Reduction should be maintained by K-wire fixation. We experienced no infection or premature epiphyseal closure.

Keywords: Seymour's fracture; Base of the distal phalanx

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