Fractures and dislocations: Seymour fracture of the distal phalanx: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

Orthopaedics · Fractures and dislocations: Seymour fracture of the distal phalanx

Sample item

A 9-year-old traps a finger in a door. The fingertip is held flexed with the nail plate lying on top of the nail fold, and the radiograph shows a fracture through the physis of the distal phalanx. What is the appropriate management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Irrigation, removal of interposed nail matrix, reduction and antibiotics

A Seymour fracture is a physeal injury of the distal phalanx with a nail bed laceration, so it communicates with the outside and behaves as an open fracture. Nail matrix can lie in the fracture and block reduction, so treatment is washout, extraction of the matrix, repair, reduction and antibiotics. Missed cases risk osteomyelitis and growth arrest.

Option by option

  • A. Irrigation, removal of interposed nail matrix, reduction and antibiotics (correct)

    Correct. The nail bed laceration makes it an open physeal fracture, so washout, matrix removal, reduction and antibiotics are needed.

  • B. Closed reduction and buddy strapping for three weeks

    Buddy strapping treats a closed, stable phalangeal injury and leaves the contaminated fracture and trapped matrix untreated.

  • C. Early active movement without immobilisation because the physis is open

    An open fracture with a displaced physis needs reduction and immobilisation, not unprotected movement.

  • D. A dorsal splint across the DIP joint for six weeks as for a mallet finger

    A mallet splint is for a tendinous extensor injury and does not address the open physeal fracture.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More Orthopaedics questions

Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is A, Irrigation, removal of interposed nail matrix, reduction and antibiotics. A Seymour fracture is a physeal injury of the distal phalanx with a nail bed laceration, so it communicates with the outside and behaves as an open fracture.

Why is "Closed reduction and buddy strapping for three weeks" not the answer?

Buddy strapping treats a closed, stable phalangeal injury and leaves the contaminated fracture and trapped matrix untreated.

Why is "Early active movement without immobilisation because the physis is op…" not the answer?

An open fracture with a displaced physis needs reduction and immobilisation, not unprotected movement.

Why is "A dorsal splint across the DIP joint for six weeks as for a mallet fi…" not the answer?

A mallet splint is for a tendinous extensor injury and does not address the open physeal fracture.

What concept does this question test?

It tests Fractures and dislocations: Seymour fracture of the distal phalanx in Orthopaedics. Nail matrix can lie in the fracture and block reduction, so treatment is washout, extraction of the matrix, repair, reduction and antibiotics. Missed cases risk osteomyelitis and growth arrest.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Fractures and dislocations: Seymour fracture of the distal phalanx?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.