AI Article Synopsis
- Seymour fractures in children have a high risk of infection and complications, making optimal management unclear.
- A systematic review and meta-analysis were conducted to evaluate the best treatment approaches, analyzing studies of patients under 18 years with these fractures.
- Results indicated that early debridement (within 48 hours) and prophylactic antibiotics (within 24 hours) significantly lower the risk of infection and malunion, highlighting the importance of prompt intervention.
- The study emphasizes that with quick recognition and basic treatment, the risks associated with Seymour fractures can be effectively reduced.
Article Abstract
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.
Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review and meta-analysis was performed. A comprehensive search strategy was applied to the MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Cochrane 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.
Type Of Study/level Of Evidence: Therapeutic IV.
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| http://dx.doi.org/10.1016/j.jhsa.2021.08.022 | DOI Listing |
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