Pediatric Hand and Wrist Fractures

Abstract

Hand and wrist fractures have been consistently reported as among the most common fractures in children. 1-3 They are 3 times more common in boys and peak in the teenage years (Fig. 1). 4 Forearm fractures compromise the largest proportion of fractures. 1 In the hand, the proximal phalanx and the fifth ray are the most commonly affected bone and digit, respectively (Fig. 2). 4 Distal phalangeal fractures tend to occur in toddlers starting to explore the world with their hands, making them susceptible to fingertip crush injuries from slammed doors. With increasing age, the distribution of fractures moves proximally, with median ages of 12 years for proximal phalanx fractures and 15 years for metacarpal fractures. This distribution corresponds to the increasing body weight and participation in sporting activities during the teenage years. CONSIDERATIONS IN THE PEDIATRIC POPULATION Epidemiologic studies generally use 17 years or 18 years of age as the limit for pediatric fractures. The unique considerations in the management of pediatric hand fractures, however, apply to children with open physes with the potential to remodel. In addition, the ability of a child to participate and cooperate in the management may Disclosure: The authors have nothing to disclose.

Seymour Fracture in a Pediatric Patient: A Case Report

“…Open injuries may warrant operative intervention given that they are more prone to soft tissue infection and development of osteomyelitis [ 3 ]. Injury-related complications include osteomyelitis, distal phalanx growth disturbance, flexion deformity, and nail deformity [ 5 ]. Treatment-related complications like a secondary fracture displacement are uncommon but have been reported [ 6 ].…”

“…Treatment for a Seymour fracture is dependent on whether it is an open or closed fracture. In the case of an open fracture that is prone to infection, it should be treated with operative irrigation, debridement, and intravenous antibiotics, along with a careful exploration to remove the proximal nail plate from the site of incarceration [ 5 - 6 ]. In closed fractures with severe soft tissue damage including the nail fold, the use of antibiotics is recommended [ 5 ].…”

The optimal management of Seymour fractures in children: a systematic review protocol

“…The rationale for formal irrigation and debridement andprophylactic antibiotics is based on principles of the managementof an open fracture and is a more widely accepted practice in morerecent years (3,7,12,13,18).…”

Protocol for a systematic review of the incidence of infection in operative vs non-operative management of Seymour fractures in children and adolescents

“…Seymour fractures are displaced, open fractures of the juxta-epiphyseal region of the distal phalanx, (1) with an overlying nail bed laceration, that occur in skeletally immature individuals. While this fracture pattern was first described by Seymour in 1966(1) the exact definition is not unanimous; the majority of sources (2)(3)(4)(5)(6)(7)(8)(9)(10)(11) define it as an open injury however several sources also include a closed injury (12,13). Seymour's original description of the fracture did not specifically comment on the presence or absence of nailbed injury, and thus the definition is subject to interpretation.…”

“…This said, in Seymour's original study, perioperative antibiotics were not given nor did 'formal debridement' occur, as described by more recent studies. (3) The rationale for formal operative management is based on principles of the management of an openfracture and is a more widely accepted practice in more recent years (3,7,12,13,17). Nonetheless, with a paucity of evidence informing the management of these fractures, equipoise exists.…”