Seymour fracture in children

In short: a Seymour fracture is a fracture of the distal phalanx close to the growth plate, associated with a nail bed injury. Because the nail bed wound places the bone in communication with the outside, it must be regarded as an open fracture, with a risk of infection. It requires urgent medical assessment and must not be managed at home.

In short

The mechanism is trivial and extremely common: a finger crushed in a door, under a lid, between two pieces of furniture, or struck by a heavy object. The apparent result is "a black finger with a lifted nail". Behind that unimpressive appearance lies a precise injury: the nail plate slips out of its fold, the nail matrix becomes interposed in the fracture line and the bone of the phalanx remains in communication with the environment through the wound.

Two consequences make this injury different from a simple contusion:

• the risk of infection, because a fracture communicating with the outside can progress to bone infection;
• the risk of malunion, because the interposed nail tissue prevents the fracture from reducing and healing correctly, with possible permanent deformity of the fingertip and nail.

Seymour fractures are underestimated precisely because they look minor. That is why they deserve a dedicated page.

Symptoms and when to worry

The features that should raise suspicion are recognisable even by a parent: the nail lifted out of its fold at the base, blood under the nail plate, a small wound around the nail base, and the fingertip bent downwards that the child cannot straighten.

With these signs assessment is urgent. This is not something to postpone to the next day, and it should not be managed with home disinfection, compressive plasters or attempts to push the nail back: any home manoeuvre only risks delaying the assessment that is actually needed.

Diagnosis and imaging

Diagnosis comes from direct inspection of the nail base and the position of the fingertip. A finger X-ray in two views confirms the fracture and defines its site and displacement; proximity to the growth plate is relevant in children. The clinical finding of a lifted nail remains decisive, however: even an unimpressive X-ray does not rule out the nail bed injury.

Treatment

Management requires a procedure performed in an appropriate setting, with effective analgesia. The defining steps are irrigation and thorough debridement of the wound, removal of tissue interposed in the fracture line, antibiotic therapy according to the case and tetanus prophylaxis when indicated, and management of the nail plate, which may be repositioned to protect the nail fold or removed depending on local conditions.

When the fracture is unstable or does not hold its reduction, fixation is added, usually with a fine wire, temporary and removed once healing has occurred. The choice between options depends on the degree of contamination, the time elapsed since injury and the condition of the tissues.

Follow-up and recovery

The finger is protected with a dressing and a splint, with close reviews in the first days to detect early signs of infection: increasing pain, redness, warmth, discharge, fever. Bone healing usually takes a few weeks; recovery of movement is generally good in children.

It should be said honestly to the family that the nail may regrow irregular or deformed even after correct treatment, and that this becomes clear over several months. The most feared complications — bone infection and growth disturbance of the phalanx — are less frequent when the injury is recognised and treated early.

Common mistakes

The most common mistake is to consider the picture "just a damaged nail" and wait. The second is to drain the blood under the nail without assessing the underlying fracture. The third is to stop follow-up as soon as pain decreases. For the general context of injuries during growth see paediatric injuries and fractures.