Typically do well with 1 week of splinting or buddy taping and then 2 weeks of active range-of-motion exercises!.X-ray may only show a very small “fleck” of bone at the avulsed site.May have reported history of dorsal dislocation.Proximal Interphalangeal Joint has an avulsion of the insertion of the volar plate at the base of the middle phalanx.Will require pinning or possible open reduction.Remodeling does not occur so anatomic reduction is imperative.Similar to lateral condyle fracture of distal humerus.Reduced fractures still need close follow-up as stability may not be definitive.Displaced fractures are unstable and require percutaneous pinning.Malunion, rotational deformity, and avascular necrosis may result.Since growth plate is proximal to the injury, remodeling is limited.Similar in supracondylar humerus fracture.Extra-articular transverse or oblique fracture.Seymour fracture complications from delayed diagnosis:.These are distinct from distal tuft fractures – as tuft fractures don’t involve the physis.Nail bed will need to be repaired and nail plate replaced and sutured to the lateral nail folds.Younger children often need percutaneous pinning ( by our Orthopaedic friends).The torn nail matrix needs to be gentle removed from wound, as it will interfere with fracture reduction.If nail bed is lacerated, treat like open fracture.If Seymour fracture is suspected, the nail plate needs to be removed to assess the nail bed integrity.The associated nail bed injury and disruption in eponychial fold and cuticle seal makes this an OPEN FRACTURE.Distal nail plate is typically still attached.Often has avulsion of the proximal nail plate (although not always apparent).Associated with laceration of the nail matrix.Distal phalanx physeal / juxtaphyseal fracture (Seymour Fracture).Open fractures may be concealed by an intact nail plate.Fractures can entrap local connective tissue (ex, volar plate).Fractures that involve the physis lead to complications associated with growth plate injuries.The growth plates are only at the proximal end of each individual phalanx.Location of fracture and fracture pattern matter.Some are prone to be more problematic though.“Buddy taping” can, however, also lead to problems.The thick periosteal sleeve helps maintain reduction position.Even displaced fractures can often be treated with closed reduction and immobilization.Buckle fractures of the phalanges are stable.Most finger fractures are treated conservatively and do well.Older children – Sports-related injuries.Young children – Household-related injuries (ex, closing doors).Of hand fractures, finger fractures are the most common.The hand is the most often injured part of a child’s body.
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