Distal phalanx fracture in adults: Seymour-type fracture

Seymour’s fracture is an extra-articular, transverse, physeal, and juxta-epiphyseal open fracture of the distal phalanx seen in childhood. In this study, we present 10 adult cases of fractures localized to the metaphyseal region, 1–2 mm distal to the insertion of the extensor tendon. Mean age was 38 years. Four patients were treated conservatively with a mallet finger splint. Closed reduction and osteosynthesis with Kirschner wires (K-wires) was performed in three of the patients. Three of the patients had open fractures in whom closed reduction could not be performed. They underwent open reduction and osteosynthesis with K-wires. We recommend that extra-articular distal phalanx fractures mimicking mallet finger in adults are called Seymour-type fracture to establish a common language among clinicians to define this type of fracture. These fractures generally occur by hyperflexion of the distal phalanx and can be treated by conservative or surgical methods. The outcomes of conservative and surgical management of Seymour-type fractures depend on the appropriate reduction as well as efficient physical therapy.

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REVIEW ON MALLET FINGER TREATMENT

Hand Surgery ◽

10.1142/s0218810412300033 ◽

2012 ◽

Vol 17 (03) ◽

pp. 439-447 ◽

Cited By ~ 29

Author(s):

Jason Pui Yin Cheung ◽

Boris Fung ◽

Wing Yuk Ip

Keyword(s):

Avulsion Fracture ◽

Articular Surface ◽

Extensor Tendon ◽

Distal Phalanx ◽

Mallet Finger ◽

Distal Interphalangeal Joint ◽

Dorsal Aspect ◽

Surgical Fixation ◽

Distal Interphalangeal ◽

Open Injuries

Mallet finger is a common injury involving either an extensor tendon rupture at its insertion or an avulsion fracture involving the insertion of the terminal extensor tendon. It is usually caused by a forceful blow to the tip of the finger causing sudden flexion or a hyperextension injury. Fracture at the dorsal aspect of the base of the distal phalanx is commonly associated with palmar subluxation of the distal phalanx. Most mallet finger injuries are recommended to be treated with immobilisation of the distal interphalangeal joint in extension by splints. There is no consensus on the type of splint and the duration of use. Most studies have shown comparable results with different splints. Surgical fixation is still indicated in certain conditions such as open injuries, avulsion fracture involving at least one third of the articular surface with or without palmar subluxation of the distal phalanx and also failed splinting treatment.

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EXTRA-ARTICULAR TRANSVERSE FRACTURES OF THE BASE OF THE DISTAL PHALANX (SEYMOUR’S FRACTURE) IN CHILDREN AND ADULTS

Journal of Hand Surgery (European Volume) ◽

10.1054/jhsb.2000.0549 ◽

2001 ◽

Vol 26 (3) ◽

pp. 201-206 ◽

Cited By ~ 45

Author(s):

M. M. AL-QATTAN

Keyword(s):

Growth Plate ◽

Closed Reduction ◽

Excellent Result ◽

Extensor Tendon ◽

Distal Phalanx ◽

Adult Patients ◽

Fracture Line ◽

Wire Fixation ◽

Adolescents And Adults ◽

Transverse Fractures

A series of 25 extra-articular transverse fractures of the base of the distal phalanx (Seymour’s fracture) in children, adolescents and adults are presented. Prior to closure of the distal phalangeal epiphysis, the fracture line is usually entirely through the metaphyses, 1 to 2 mm distal to the growth plate. In adults, the fracture line is just distal to the insertion of the extensor tendon. Eighteen of these fractures were treated by closed reduction and splinting and one of these developed an infection and three had mild residual flexion deformities of the finger. Five fractures were treated by K-wire fixation and all healed without complications. Two adult patients presented 4 to 5 weeks after injury with malunion, and of these one underwent refracturing and K-wire fixation with an excellent result.

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Effectiveness of Quickcast Versus Custom-Fabricated Thermoplastic Orthosis Immobilization for the Treatment of Mallet Fingers: A Randomized Clinical Trial

Hand ◽

10.1177/1558944720988136 ◽

2021 ◽

pp. 155894472098813

Author(s):

Priscilla K. Cavanaugh ◽

Cynthia Watkins ◽

Christopher Jones ◽

Mitchell G. Maltenfort ◽

Pedro K. Beredjiklian ◽

...

Keyword(s):

Clinical Trial ◽

Soft Tissue ◽

Randomized Clinical Trial ◽

Surgical Intervention ◽

Extensor Tendon ◽

Distal Phalanx ◽

Mallet Finger ◽

Secondary Surgery ◽

Significant Difference ◽

Extensor Lag

Background: Mallet finger is a common injury involving a detachment of the terminal extensor tendon from the distal phalanx. This injury is usually treated with immobilization in a cast or splint. The purpose of this study is to compare outcomes of mallet fingers treated with either a cast (Quickcast) or a traditional thermoplastic custom-fabricated orthosis. Methods: Our study was a prospective, assessor-blinded, single-center randomized clinical trial of 58 consecutive patients with the diagnosis of bony or soft tissue mallet finger treated with immobilization. Patients were randomized to either an orfilight thermoplastic custom-fabricated orthosis or a Quickcast orthosis. Patients were evaluated at 3, 6, and 10 weeks for bony and 4, 8, and 12 weeks for soft tissue mallets. Skin complications, pain with orthosis, compliance, need for surgical intervention, and extensor lag were compared between the 2 groups. Results: Both bony and soft tissue mallet finger patients experienced significantly less skin complications (33% vs 64%) and pain (11.2 vs 21.6) when using Quickcast versus an orfilight thermoplastic custom-fabricated orthosis. The soft tissue mallet group revealed a greater difference in pain, favoring Quickcast (6.2 vs 22). No significant difference in final extensor droop or need for secondary surgery was found between the 2 groups. Conclusions: Quickcast immobilization for the treatment of mallet finger demonstrated fewer skin complications and less pain compared with orfilight custom-fabricated splints.

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Distal interphalangeal Joint Arthrodesis using only Kirschner Wires in small distal Phalanges

Handchirurgie · Mikrochirurgie · Plastische Chirurgie ◽

10.1055/a-1559-2684 ◽

2021 ◽

Vol 53 (05) ◽

pp. 462-466

Author(s):

Jun-Ku Lee ◽

Soonchul Lee ◽

SeongJu Choi ◽

Dong Hun Han ◽

Jongbeom Oh ◽

...

Keyword(s):

Distal Phalanx ◽

Bony Union ◽

Dash Score ◽

Medical Database ◽

X Ray ◽

Wire Fixation ◽

Distal Interphalangeal ◽

K Wires ◽

Quick Dash

Abstract Purpose To report the clinical and radiographic results of arthrodesis of relatively small-sized distal interphalangeal joints (DIPJs) using only K-wire fixation. Patients and methods Between January 2000 and December 2018 28 arthrodesis in 21 patients (9 males and 12 females with an average age of 52.1 years) with relatively small-sized DIPJs were performed using only K-wires. Data on patient’s characteristics, such as age, sex, affected finger, and the number and size of the used k-wires were collected from the medical database. The narrowest diameter of the cortex and medulla of the distal phalanx was measured on preoperative plain radiographs. The time to union and the arthrodesis angle was determined using serial X-ray radiography follow-up. Preoperatively and at the latest follow-up examination, pain using the visual analogue scale (VAS) and the quick DASH score was registered. In addition, complications were investigated. Results Average follow-up period was 11.4 months. The small finger was mostly affected (n = 12; 42.9 %). The narrowest diameters of the distal phalanx cortex and the medulla measured on preoperative X-ray images were 2.8 mm (SD 0.5) and 1.2 mm (SD 0.4), respectively. Seven fusions were done with use of 1 K-wire, 20 with 2 (71.4 %), and 1 with 3 K-wires. The most common K-wire sizes were 1.1-inch (24 K-wires = 48 %), and 0.9 inch (21 K-wires = 42 %) The preoperative VAS score and quick DASH score improved from 6.1 (range: 0–9) and 25.8 (range: 2–38) to 0.4 (range: 0–2) and 3.4 (range: 0–10.2), respectively. 25 (89.3 %) out of 28 fingers achieved bony union in an average of 96.1 days (range: 58–114) with three non-union. Conclusion Arthrodesis of small DIPJs with K-wire fixation has a high success rate. Therefore, we suggest K-wire fixation as an acceptable alternative for patients with a small phalanx which may be at risk of mismatch with bigger implants. However, concerns remain in terms of fusion delay with K-wire only fixation.

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Displaced Epiphyseal Plate of the Terminal Phalanx in a Child

HAND ◽

10.1016/s0072-968x(80)80029-5 ◽

1980 ◽

Vol os-12 (1) ◽

pp. 51-53 ◽

Cited By ~ 15

Author(s):

E. Michelinakis ◽

H. Vourexaki

Keyword(s):

Open Reduction ◽

Extensor Tendon ◽

Normal Growth ◽

Epiphyseal Plate ◽

Mallet Finger

A case of mallet finger in a child is described. The epiphysis of the terminal phalanx was displaced dorsally with the extensor tendon attached to it, and was first diagnosed two weeks after injury. The treatment was by open reduction. Radiograph three years later showed that a satisfactory position of the epiphysis and normal growth of the terminal phalanx had occurred.

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Open Fracture of the Acromion: An Isolated Injury with Oblique-Type Fracture

Case Reports in Orthopedics ◽

10.1155/2018/2107059 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3

Author(s):

Mohammad O. Alawad ◽

Saleh Alharthi ◽

Jameel Mahmoud ◽

Basam Alanazi ◽

Saad Surur

Keyword(s):

Clinical Outcome ◽

Open Fracture ◽

Screw Fixation ◽

Fracture Classification ◽

Good Recovery ◽

Scapular Fracture ◽

Type Fracture ◽

Isolated Injury ◽

Acromial Fracture ◽

Excellent Clinical Outcome

Open acromial fractures are a rare set of fractures. We report a case of Gustilo IIIA open acromial fracture (14A2 as per OTA scapular fracture classification) that was isolated from any other injury. Our patient had a good recovery and showed excellent clinical outcome after irrigation and screw fixation of the acromial fracture. We also reviewed the literature for other cases of open acromial fracture.

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Non-Union in a Fracture of the Shaft of the Distal Phalanx

HAND ◽

10.1016/s0072-968x(82)80049-1 ◽

1982 ◽

Vol os-14 (1) ◽

pp. 85-88 ◽

Cited By ~ 9

Author(s):

L. Read

Keyword(s):

Open Reduction ◽

Kirschner Wire ◽

Middle Finger ◽

Distal Phalanx ◽

Non Union ◽

Shaft Fractures ◽

Kirschner Wire Fixation ◽

Wire Fixation ◽

Type Of Fracture

Fracture of the shaft of the distal phalanx is less common than more distal fractures involving the tuft: non-union in such a fracture is even more unusual. A case is described in which troublesome non-union of the shaft of the distal phalanx of the middle finger was successfully treated by open reduction and Kirschner wire fixation. The type of fracture and its treatment is discussed: it is emphasised that the principles applied to shaft fractures of the middle and proximal phalanges also apply to the distal phalanx.

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Evaluation of the short-term results of closed reduction and percutaneous K-wires fixation of displaced intra-articular calcaneal fractures (DIACF)

The Foot ◽

10.1016/j.foot.2020.101740 ◽

2020 ◽

Vol 45 ◽

pp. 101740

Author(s):

Ibrahim Mahmoud Morsi ◽

Ahmed A. Khalifa ◽

Mohamed Abdelmoneim Hussien ◽

Ahmed Abdellatef ◽

Hesham Refae

Keyword(s):

Closed Reduction ◽

Calcaneal Fractures ◽

Short Term ◽

K Wires

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Tethering the Extensor Apparatus Limits PIP Flexion Following K-wire Placement for Pinning Extra-articular Fractures at the Base of the Proximal Phalanx

Hand ◽

10.1177/1558944716628498 ◽

2016 ◽

Vol 11 (4) ◽

pp. 433-437 ◽

Cited By ~ 4

Author(s):

Yaron Sela ◽

Caitlin Peterson ◽

Mark E. Baratz

Keyword(s):

Insertion Site ◽

Proximal Phalanx ◽

Extensor Tendon ◽

Metacarpophalangeal Joint ◽

Minimally Invasive Surgical ◽

Articular Fractures ◽

Pip Joint ◽

Joint Flexion ◽

The Mean ◽

K Wires

Background: Closed reduction with percutaneous Kirschner wires (K-wires) is the most minimally invasive surgical option for stabilizing phalanx fractures. This study examines the effect of K-wire placement on proximal interphalangeal (PIP) joint motion. Methods: PIP joint flexion was measured in the digits of 4 fresh-frozen cadaver hands after placing a suture loop through the flexor tendons and placing tension on the flexors via a mechanical scale. The load necessary to flex the PIP joint to 90° or to maximum flexion was recorded. The load was removed and K-wires were inserted in 3 locations about the metacarpophalangeal joint (MPJ): through the extensor tendon and across the MPJ, adjacent to the extensor tendon insertion site and across the MPJ, and through the sagittal band and into the base of the proximal phalanx (P1). The load on the tendons was reapplied, and angles of PIP joint flexion were recorded for each of the 3 conditions. Results: The mean angle of PIP joint flexion prior to K-wire insertion was 87°, and the mean load applied was 241 g. The angles of flexion were 53° when the K-wire was placed through the extensor tendon, 70° when the K-wire was placed adjacent to the tendon, and 75° when the K-wire was placed into the base of P1 by going through the sagittal band, midway between the volar plate and the extensor tendon. Conclusions: K-wires placed remote from the extensor tendon create less of an immediate tether to PIP joint flexion than those placed through or adjacent to the extensor tendon.

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