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Salter-Harris Fractures of the Distal Phalanx

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 (more than 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 Seymour N. Juxta-epiphysial fracture of the terminal phalanx of the finger. J Bone Joint Surg Br. 1966;48:347–349. Instagram: ⁠  / ⁠     Spotify: ⁠https://open.spotify.com/show/4Ct8jOg... Apple: ⁠https://podcasts.apple.com/us/podcast... YouTube: ⁠   / @plasticsinpractice   Amazon: ⁠https://music.amazon.com/podcasts/8be... 📘 Free Study Guides: → ⁠https://drive.google.com/drive/u/0/fo...