Open fracture of the distal phalanx

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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The use of Prophylactic Flucloxacillin in Treatment of Open Fractures of the Distal Phalanx within an Accident and Emergency Department: A Double-Blind Randomized Placebo-Controlled Trial

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(03)00175-x ◽

2003 ◽

Vol 28 (5) ◽

pp. 388-394 ◽

Cited By ~ 39

Author(s):

J. STEVENSON ◽

G. MCNAUGHTON ◽

J. RILEY

Keyword(s):

Emergency Department ◽

Open Fracture ◽

Controlled Trial ◽

Distal Phalanx ◽

Open Fractures ◽

Controlled Study ◽

Double Blind ◽

Accident And Emergency ◽

Significant Difference ◽

Accident And Emergency Department

Open fractures of the distal phalanx commonly present to the Accident and Emergency Department. Controversy surrounds the use of prophylactic antibiotics in treating this injury. A double-blind, prospective, randomized placebo-controlled study was undertaken comparing the use of prophylactic flucloxacillin to placebo in addition to meticulous wound toilet. One hundred and ninety-three adult patients with an open fracture of the distal phalanx were studied. Seven patients developed superficial infections, an overall infection rate of 4%. No patient developed osteitis or a deep wound infection. There were three cases of infection in the 98 patients (3%) in the antibiotic group and four cases of infection in the 95 patients (4%) in the placebo group. A difference of proportion test confirmed no significant difference. It is concluded that the addition of prophylactic flucloxacillin to thorough wound toilet and careful soft-tissue repair of open fracture of the distal phalanx confers no benefit.

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Paediatric Hand Injuries Caused by Spiked Railings

Journal of Hand Surgery (European Volume) ◽

10.1054/jhsb.1999.0206 ◽

1999 ◽

Vol 24 (5) ◽

pp. 615-616 ◽

Cited By ~ 2

Author(s):

T. RASHEED ◽

C. HILL ◽

K. KHAN ◽

M. BRENNEN

Keyword(s):

Open Fracture ◽

Distal Phalanx ◽

Hand Injuries ◽

Digital Nerve ◽

Nerve Injuries ◽

Nail Bed

We report five cases of hand injuries caused by spiked palisade railings. One patient sustained an open fracture of the distal phalanx with a disruption of the nail bed, and two patients had digital nerve injuries. Two patients presented with the railing still impaled in the fingers, one of whom had an ischaemic digit at presentation. All patients were male, between 9 and 12 years of age, and presented in the course of 1 month. Railings of this type would appear to be a significant cause of hand injuries, which may be prevented by legislation or a change in railing design.

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Pinckney fracture: do not underestimate trauma of the distal phalanx of the hallux

BMJ Case Reports ◽

10.1136/bcr-2021-244985 ◽

2021 ◽

Vol 14 (9) ◽

pp. e244985

Author(s):

João Nóbrega ◽

Joana Ovídio ◽

Joana Arcângelo ◽

João Campagnolo

Keyword(s):

Emergency Department ◽

Open Fracture ◽

Tissue Injury ◽

Soft Tissue Injury ◽

Distal Phalanx ◽

Type I ◽

Nail Bed ◽

Low Threshold ◽

Salter Harris ◽

High Index Of Suspicion

Toe injuries are common in the emergency department and most of them are treated conservatively. In some circumstances, these injuries can present as a physeal fracture with concomitant soft-tissue injury affecting the nail bed and resulting in a hidden open fracture. To adequately treat these patients, a high index of suspicion is needed to diagnose and treat the open fractures and to prevent complications such as infection, osteomyelitis, malunion and premature physeal arrest.We report a case of a patient that was admitted to the hospital with a Salter-Harris type I fracture of the distal phalanx of the hallux. After confirming the diagnosis, antibiotic treatment was started and the fracture was reduced and fixed.The literature on this entity is sparse and most of the management protocols are based on its hand equivalent—the Seymour fracture, emphasising the low threshold for treating these lesions as an open fracture.

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MRI Findings of Post-Traumatic Osteomyelitis of Distal Phalanx Following Neglected Open Fracture

Journal of the Korean Society of Radiology ◽

10.3348/jksr.2017.77.1.53 ◽

2017 ◽

Vol 77 (1) ◽

pp. 53

Author(s):

Dong Eon Kim ◽

Jihae Lee ◽

Kung Eun Bae ◽

Mi-Jin Kang ◽

Jae Hyung Kim ◽

...

Keyword(s):

Open Fracture ◽

Distal Phalanx ◽

Mri Findings ◽

Post Traumatic

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Internal fixation of an unstable open fracture of a distal phalanx with a Herbert screw

The Journal Of Hand Surgery ◽

10.1016/s0363-5023(88)80024-8 ◽

1988 ◽

Vol 13 (3) ◽

pp. 428-432 ◽

Cited By ~ 11

Author(s):

Robin R. Richards ◽

Ghassan Khoury ◽

M. Christine Young

Keyword(s):

Internal Fixation ◽

Open Fracture ◽

Distal Phalanx ◽

Herbert Screw

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Self-made adjustable external fixation device with progressive compression for the management of open fracture with bone defects of the distal hallux phalanx: a case report

10.21203/rs.2.23035/v1 ◽

2020 ◽

Author(s):

Ying-Guo YANG ◽

Da-Ke Tong ◽

peizhao Liu

Keyword(s):

Soft Tissue ◽

External Fixation ◽

Open Fracture ◽

Low Cost ◽

Bone Defects ◽

Distal Phalanx ◽

Fixation Device ◽

Non Union ◽

External Fixation Device

Abstract Background: Open fractures with bone defects of the distal phalanx of the hallux are both rare and complicated, and these conditions pose great clinical challenge to orthopedists as improper handling can lead to distal tissue necrosis, osteomyelitis, malunion, non-union and even amputation. Due to the lack of soft tissue and bone and the blocking effect caused by un-disconnected soft tissue, it is relatively difficult to achieve effective reduction and fixation of the fracture by traditional methods. Methods: we present a patient, diagnosed with open fracture combined with bone defects of the distal segment of the great toe, who was treated using a self-made adjustable external fixation device by complete debridement, effective closed reduction and continuous adjustment. Complications were registered and clinical outcome was measured at the follow-up periods. Results: The device was simple to make with a low cost and practicality, and this technique resulted in effective maintenance of reduction and progressive compression in the fracture ends. The patient finally obtained optimal fracture healing and satisfactory function of the injured toe at last follow-up. Conclusions: The self-made adjustable external fixation device is reliable in maintaining reduction and fixation, which provides an alternative for the management of open fracture associated with bone absence of the distal phalanx of the hallux.

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Seymour’s Fracture in a 13-years-old Child: A Case Report

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i05.2200 ◽

2021 ◽

Vol 11 (55) ◽

Author(s):

Tarang S. Khairnar ◽

Sandeep A. Patwardhan ◽

Vivek M. Sodhai ◽

Ashok K. Shyam ◽

Parag K. Sancheti

Keyword(s):

Case Report ◽

Open Fracture ◽

Ring Finger ◽

Distal Phalanx ◽

Nail Bed ◽

Excellent Outcome ◽

Physeal Injury ◽

Injury Reduction ◽

Absorbable Sutures ◽

High Index Of Suspicion

Introduction: A nail bed injury concomitant with an underlying physeal injury of the distal phalanx is termed as “Seymour’s fracture.” These are seemingly innocuous injuries commonly misdiagnosed and are subsequently under-treated. These injuries demand treatment like an open fracture to prevent complications such as infection, growth arrest, and nail dystrophies. Case Report: A 13-year-old boy suffered Seymour’s fracture of the left ring finger distal phalanx after a direct injury from a dodge ball. The fracture was treated with thorough debridement with normal saline, physeal injury reduction through the wound, and fixation with k-wire passed through the tip of the ring finger, metaphysic, physis, and the tip of the k-wire ending in the epiphysis of the distal phalanx. The nail bed was sutured with 3–0 monofilament absorbable sutures. The fracture healed at 3 months and a 1-year follow-up showed a completely formed nail without any deformity. Conclusion: Excellent outcome was observed with debridement of the wound, nail bed repair, and fixation with k-wire in our case. Nail bed injuries in children should be treated with a high index of suspicion for Seymour’s fracture as it necessitates treatment like that of an open fracture to avoid complications. Keywords: Mallet finger, Nail bed injury, Open fracture, Physeal injury, Seymour’s fracture.

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