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

INTRODUCTION: 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. METHODS: 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. RESULTS: 69 papers were found using the reported search strategy, and eight papers representing the best evidence to answer this question are discussed. DISCUSSION: 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. CONCLUSION: 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.