Does K-wire fixation improve outcomes in children with a Seymour fracture?

The Seymour fracture is a juxta-epiphyseal fracture of the terminal phalanx of the finger. Sources vary on the recommended management, with some advocating treatment without K-wires to avoid metalwork-associated infection, and others suggesting that K-wire fixation is necessary due to the risks of fracture re-displacement. A best evidence topic in paediatric hand surgery was written according to a structured protocol. Searches were performed on December 28, 2021 in Cochrane library and PubMed. 69 papers were found using the reported search strategy, and eight papers representing the best evidence to answer this question are discussed. The evidence on this subject is suboptimal as five of these studies were case-series that do not make direct comparisons between the question's intervention and control groups, and the other three were single-centre retrospective cohort studies with no randomisation. The best evidence topic concludes that K-wire fixation appears to be associated with a higher rate of physeal disturbance and lower rates of infection, fracture re-displacement, and flexion deformity. •K-wire fixation appears to be associated with higher rates of physeal disturbance.•And with lower rates of infection, fracture re-displacement, and flexion deformity.•Most will have normal clinical and radiographic findings at long-term follow-up.