What’s the Diagnosis – Case 147
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Findings Lateral radiograph demonstrates a Salter Harris I/II injury with asymmetric dorsal widening of the physis, slight flexion of the distal phalanx, and a small dorsal bone fleck. MRI demonstrates the same physeal injury with asymmetric dorsal physeal injury and with injury extending through the germinal matrix to the nail plate. As the anatomy in this location is difficult and may be more unfamiliar than other locations, following is an illustration of the anatomy from the internet and a Frank Netter drawing from his anatomy atlas.
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Diagnosis: Seymour Fracture Seymour fracture is a pediatric injury similar to the mallet finger in the adult. It occurs when forced flexion causes an extension moment about the DIP. In the skeletally immature patient a mallet finger injury can occur where the fracture is seen to extend into the joint or a Seymour fracture can be sustained. As seen in this case, the injury causes a widening of the physis and may cause low grade injury to the metaphysis but does not extend into the DIP joint. Because of the injury about the extensor apparatus the distal phalanx falls into mild flexion. With the injury propagating into the germinal matrix and nail plate or nail bed these injuries are treated as open fractures necessitating anitibiotics, nail plate removal with irrigation and debridement, nailbed repair, and fracture reduction. Although the injury appears somewhat innocuous, if not treated appropriately it can lead to chronic osteomyelitis, flexion deformity, growth disturbance, or nail abnormalities.
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References Treatment of Acute Seymour Fractures. Lin, James S. MD; Popp, James E. MD,; Balch Samora, Julie MD, PhD. Journal of Pediatric Orthopaedics. January 2019, Volume 39 (1), p e23–e27. doi: 10.1097/BPO.0000000000001275. ISSN: 0271-6798 Complex Pediatric Fracture, Seymour Fracture - Everything You Need To Know - Dr. Nabil Ebraheim Netter’s Concise Atlas of Orthopedic Anatomy. Jon C. Thompson, MD. ISBN13: 978-0914168942. ISBN-10: 0914168940
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