Seymour fractures are small injuries with big consequences. These pediatric distal phalanx fractures can easily be overlooked — but missing the nail-bed involvement means missing an open fracture.

In this episode of Plastics in Practice, we dive into the clinical entity first described by Seymour nearly 50 years ago: pediatric distal phalanx Salter-Harris I/II or juxta-epiphyseal fractures. We review how tendon insertions create the characteristic mallet deformity, why nail-bed lacerations matter, and how management has evolved.

Key Takeaways:

• Red Flags: Subungual hematoma, nail plate subluxation, or nail fold laceration should raise suspicion for a Seymour fracture .

• Open Fracture Principle: Nail-bed laceration = open fracture → requires irrigation, debridement, reduction, and antibiotics .

• Timing Matters: Delayed presentation (>48 hrs) significantly increases infection and osteomyelitis risk .

• Surgical Algorithm: Stable fractures → splinting; unstable → pinning; always explore when nail-bed injury is suspected .

• Outcomes: Early recognition and appropriate management lead to excellent functional and aesthetic results.

References:

• Gibreel W, Charafeddine A, Carlsen BT, Moran SL, Bakri K. Salter-Harris Fractures of the Distal Phalanx: Treatment Algorithm and Surgical Outcomes. Plast Reconstr Surg. 2018;142(3):720–729. doi:10.1097/PRS.0000000000004645