title: Open physeal fracture of the distal phalanx of the hallux.
abstract: Open physeal fractures of the distal phalanx of the hallux are the lesser described counterpart to the same fracture of the finger, known by its eponym as a "Seymour fracture". Displaced Salter-Harris phalangeal fractures present with a concomitant nailbed or soft tissue injury. Often these fractures occur in the summer months when open-toe footwear can be worn, however, they may occur indoors as well. Frequently, the injury results from direct axial load of the toe, or "stubbing", which causes the fracture and associated soft tissue injury. Prompt diagnosis and appropriate treatment is necessary to prevent negative sequelae such as osteomyelitis, malunion, nonunion, or premature growth arrest. In this article, we present a 12year-old male who sustained an open physeal fracture of the distal phalanx when he "stubbed" his great toe on a bed post. His injury was initially misdiagnosed at an urgent care facility, thereby delaying appropriate intervention and necessitating an operative surgical procedure. Additionally, we review the existing literature discussing these infrequently reported injuries, as well as present key points as they pertain to the diagnosis and management of this injury in the emergency department.
authors.affiliation: Kansas University Medical Center, Department of Orthopedic Surgery, Kansas City, KS, United States. Electronic address: bmorris3@kumc.edu.
authors.forename: Brandon
authors.initials: B
authors.lastname: Morris
authors.affiliation: Kansas University Medical Center, Department of Orthopedic Surgery, Kansas City, KS, United States.
authors.forename: Scott
authors.initials: S
authors.lastname: Mullen
authors.affiliation: Kansas University Medical Center, Department of Orthopedic Surgery, Kansas City, KS, United States.
authors.forename: Paul
authors.initials: P
authors.lastname: Schroeppel
authors.affiliation: Kansas University Medical Center, Department of Orthopedic Surgery, Kansas City, KS, United States.
authors.forename: Bryan
authors.initials: B
authors.lastname: Vopat
mesh_terms: D002648:Child; D003646:Debridement / Q000379:methods; D057210:Delayed Diagnosis; D005593:Fracture Fixation, Internal / Q000379:methods; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000601:surgery; D005597:Fractures, Open / Q000000981:diagnostic imaging* / Q000601:surgery; D006214:Hallux / Q000000981:diagnostic imaging* / Q000293:injuries / Q000601:surgery; D006801:Humans; D008297:Male; D010019:Osteomyelitis / Q000517:prevention & control*; D011859:Radiography; D017695:Soft Tissue Injuries / Q000601:surgery*; D007507:Therapeutic Irrigation / Q000379:methods; D016896:Treatment Outcome