Management of Seymour Fractures in Children and Adolescents: A Systematic Review and Meta-Analysis

Purpose Seymour fractures are injuries with a potentially high risk of infection and osteomyelitis. The optimal management of this pediatric open fracture is unknown. We performed a systematic review and meta-analysis to summarize the best evidence for these fractures and determine their optional management based on primary clinical studies. tematic review and meta-analysis was performed. A comprehensive search strategy was applied to Library, and gray literature databases (from May 1966 to April 15, 2020). Studies describing patients under the age of 18 years with Seymour fractures were included. Treatment was grouped based on debridement and antibiotic status as well as the timing of these interventions. The primary outcome was infection. The secondary outcomes included malunion, physeal disturbance, and nail dystrophy.Results The searches helped identify 56 records, of which 10 nonrandomized studies met our inclusion criteria, comprising 352 patients and 355 fractures. Early (< 48 hours) debridement was associated with significantly less risk of infection (risk ratio [RR] = 0.28 [95% CI, 0.12-0.64]) and malunion (RR = 0.25 [95% CI, 0.07-0.99]). Prophylactic (< 24 hours) antibiotics significantly reduced the risk of infection (RR = 0.21 [95% CI, 0.10-0.43]). In addition, prophylactic antibiotics and debridement were associated with a 70% reduction in the risk of infection (RR = 0.30 [95% CI, 0.11-0.83]). Over one-third of patients with delayed presentation (median 8.5 days) were infected at presentation. Conclusions The high-risk nature of Seymour fractures may be mitigated by prompt recognition and early, basic interventions, which can usually be performed in any setting. (J Hand Surg Am. 2022;47(12):1223.e1-e20. Copyright (c) 2022 by the American Society for Surgery of the Hand. All rights reserved.) Type of study/level of evidence Therapeutic IV.