gms | German Medical Science

Introduction: Longitudinal bone growth is influenced by a number of nutritional, hormonal and genetic factors. The mechanism for growth plate fusion is not fully understood yet. One hypothesis indicates that delayed fusion may be related to deficiency or resistance to oestrogen in adolescence. We present the first reported Seymour fracture (Salter Harris I) in an adult with failed growth plate fusion.

Case Report: A 19.5 year old man presented with a left (non-dominant) little finger open juxta - epiphyseal fracture of distal phalanx. This was consisted with a Seymour type fracture (Salter Harris I) with involvement of nail bed, germinal matrix and unugal subluxation. The injury was secondary to a fall from a bicycle 2 days prior to our clinic review. Five days post injury, the injury was managed with open reduction, nail bed repair (6/0 vicryl rapide) and one axial K-wire (0.9 mm) fixation. Further clinical assessment based on Greulich and Pyle (GP) and Tanner-Whitehouse (TW) revealed bone age of 14.5 and 14.3 years respectively. The K-wire was removed 4 weeks post-operatively and DIPJ was splinted for further 2 weeks. The patient regained normal extension of DIPJ post rehabilitation and was followed-up for 6 months without any functional deficit. A referral to endocrinology team was made to rule out any growth hormone, thyroid or pituitary related diagnoses.

Conclusion: The correlation of radiological bone age was a key to guide our management of the first reported Seymour fracture in an adult. Actual age should not be the sole indicator to rule out juxta-epiphyseal fractures in adolescent patients. The management of Seymour fractures should be according to bone age rather than actual age.