Seymour fracture is a complex pediatric fracture of the
fingers or the toes. It is an extra articular transverse Salter Type I or Type
II fracture at the base of the distal phalanx of the fingers or the toes. There
is a flexion injury that leads to physeal separation between the extensor
tendon dorsally and the flexor digitorum profundus volarly. This flexion injury
which causes flexion of bone also causes avulsion of the proximal edge of the
nail from the nail fold. In addition to disruption of the nail plate, there is
a disruption of the germinal matrix. The patient will have pain, swelling, and
deformity. The finger will appear flexed, and it will look like a mallet finger
with the nail appearing too long compared to the nail on the other side. There
is blood coming from the root of the nail. This injury is an open fracture, it
is not a mallet finger fracture, and it should not be treated with a splint
alone. When you see bleeding around the nail bed in a child, be suspicious of a
Seymour fracture. If the fracture is missed, there may be complications such as
infection and finger deformity. Because this is an open fracture, you must give
the patient antibiotics. The patient will need to go to the operating room for
nail removal and debridement of the wound. Reduce the fracture, fix it with a
K-wire and repair the nail bed. Splint the fracture or use a cast for
protection.
