NEGLECTED SEYMOUR FRACTURES OF THE HALLUX IN CHILDREN: FIXATION VERSUS NO FIXATION, AND TRANSARTICULAR VERSUS EXTRA-ARTICULAR TECHNIQUE.

BACKGROUND: Open Seymour fractures of the hallux, distinct from closed physeal injuries, lack a clear optimal stabilization strategy when presentation is delayed. PURPOSE: To compare reduction maintenance and recovery of interphalangeal (IP) motion after three operative strategies for neglected, open hallux Seymour fractures. STUDY DESIGN: Retrospective comparative cohort study. METHODS: Forty-four children presenting more than 48 hours after injury underwent irrigation, debridement, and nail bed repair, with transarticular fixation (TFx, n=16), extra-articular crossed-wire fixation (EFx, n=17), or no skeletal fixation (NoFx, n=11). Minimum follow-up was 12 months. Categorical outcomes were compared with exact tests; continuous outcomes with Kruskal-Wallis tests and adjusted pairwise comparisons. RESULTS: Loss of reduction occurred in 5/11 NoFx patients versus 0/33 fixed patients (p < 0.001). Median time to full IP motion was 77 days in TFx versus 56 days in both EFx and NoFx (TFx vs EFx, p = 0.002 after adjustment). Physeal alteration occurred in 3/16 TFx, 3/17 EFx, and 7/11 NoFx patients (overall p = 0.027), though pairwise comparisons were not significant. All 5 patients with loss of reduction had physeal alteration, versus 8/39 without (exploratory p = 0.001). Osteomyelitis occurred in 12/44 patients and correlated with longer treatment delay. CONCLUSIONS: Fixation was associated with maintained reduction in this neglected, open-injury cohort. Extra-articular fixation showed earlier recovery of full IP motion than transarticular fixation, with no loss of reduction in either fixed group. These findings support joint-sparing fixation when feasible but do not establish causal superiority or identify which fractures may safely remain unfixed. LEVEL OF EVIDENCE: Level III, retrospective comparative study.