Middle phalanx base fractures managed with Suzuki frame: a series of 23 patients

Authors

  • Nawaz Ahmad Bhat Department of Orthopaedics, Government Medical College Anantnag, Jammu and Kashmir, India
  • John M. Department of Orthopaedics, Government Medical College Anantnag, Jammu and Kashmir, India
  • Zubair Ahmad Lone Department of Orthopaedics, Government Medical College Jammu, Jammu and Kashmir, India
  • Tanveer Ahmed Bhat Department of Orthopaedics, Government Medical College Jammu, Jammu and Kashmir, India
  • Abdul Ghani Department of Orthopaedics, Government Medical College Jammu, Jammu and Kashmir, India
  • Mohammed Farooq Butt Department of Orthopaedics, Government Medical College Jammu, Jammu and Kashmir, India
  • Sanjeev Gupta Department of Orthopaedics, Government Medical College Jammu, Jammu and Kashmir, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20230023

Keywords:

Phalanx fracture, Suzuki frame, Pin and rubber traction

Abstract

Background: Intra-articular fractures of the base of middle phalanx are difficult to manage. With many known methods of treatment available, the authors present their experience of managing these injuries by Suzuki’s pin and rubber traction method.

Methods: A prospective study of five years duration which included 23 patients. All the patients were managed with Suzuki’s pin and rubber traction system. The primary outcome variable was ROM at the PIP joint. The secondary outcome variable was the complication profile. 

Results: The mean ROM at the PIP joint at the final follow-up was 80±12.2 (range: 50-100) degrees. The mean flexion at PIP joint at the final follow-up was 82.72±10.5 degrees and the mean extension at PIP joint was -2.7±4.5 degrees. No case of non-union was observed in the present study. Pin tract infection occurred in 17.39% of cases and was the commonest complication observed. Two patients needed realignment of K-wires for pin displacement. One patient developed osteomyelitis of middle phalanx at three weeks and needed early removal of hardware. The same patient also developed complex regional pain syndrome (CRPS) at two months. One patient developed painful arthritis of PIP joint.

Conclusions: Suzuki’s pin and rubber traction method is an effective modality of treatment for intra-articular fractures of the base of proximal phalanx of fingers of hand. Although, not free of complications the final results in most patients are good. However, the authors recommend large randomized control trials to be held for these injuries to compare carious modalities of treatment.

References

Finsen V. Suzuki's pins and rubber traction for fractures of the base of the middle phalanx. J Plast Surg Hand Surg. 2010;44(4-5):209-13.

Blazar PE, Steinberg DR. Fractures of the proximal inter phalangeal joint. J Am Acad Orthop Surg. 2000;8:383-90.

Seno N, Hashizume H, Inoue H, Imatani J, Morito Y. Fractures of the base of the middle phalanx of the finger. Classification, managementand long-term results. J Bone Joint Surg Br. 1997;79:758-63.

Suzuki Y, Matsunaga T, Sato S, Yokoi T. The pins and rubbers traction system for treatment of comminuted intraarticular fracturesand fracture-dislocations in the hand. J Hand Surg Br. 1994;19:98-107.

De Smet L, Fabry G. Treatment of fracture-dislocations of the proximal interphalangeal joint with the "pins and rubbers" traction system. Acta Orthop Belg. 1998;64:229-32.

Majumder S, Peck F, Watson JS, Lees VC. Lessons learned from the management of complex intra-articular fractures at the base of the middle phalanges of fingers. J Hand Surg Br. 2003;28:559-65.

Keramidas E, Solomos M, Page RE, Miller G. The Suzuki frame for complex intra-articular fractures of the proximal inter phalangeal joint of the fingers. Ann Plast Surg. 2007;58:484-8.

Salter RB. The physiologic basis of continuous passive motion for articular cartilage healing and regeneration. Hand Clin. 1994;10:211-9.

Nilsson JA, Rosberg HE. Treatment of proximal interphalangeal joint fractures by the pins and rubbers traction system: a follow-up. J Plast Surg Hand Surg. 2014;48(4):259-64.

Duteille F, Pasquier P, Lim A, Dautel G. Treatment of complex interphalangeal joint fractures with dynamic external traction: a series of 20 cases. Plast Reconstr Surg. 2003;111:1623-9.

Debus G, Courvoisier A, Wimsey S, Pradel P, Moutet F. Pins and rubbertraction system for intra-articular proximal interphalangeal joint fractures revisited. J Hand Surg Eur. 2010;35:396-401.

Glickel SZ, Barron OA. Proximal interphalangeal joint fracture dislocations. Hand Clin. 2000;16:333-44.

Agarwal AK, Karri V, Pickford MA. Avoiding pitfalls of the pins and rubbers traction technique for fractures of the proximal interphalangeal joint. Ann Plast Surg. 2007;58:489-95.

Finsen V. Suzuki’s pins and rubber traction for fractures of the base of the middle phalanx. J Plast Surg Hand Surg. 2010;44:209-13.

De Soras X, De Mourgues P, Guinard D, Moutet F. Pins and rubbers traction system. J Hand Surg (Br). 1997;22:730.

Deshmukh SC, Kumar D, Mathur K, Thomas B. Complex fracture-dislocation of the proximal interphalangeal joint of the hand. Results of a modified pins and rubbers traction system. J Bone Joint Surg Br. 2004;86:406-12.

Ruland RT, Hogan CJ, Cannon DL, Slade JF. Use of dynamic distraction external fixation for unstable fracture-dislocations ofthe proximal interphalangeal joint. J Hand Surg Am. 2008;33:19-25.

El Khatib K, Kadlub N, Trost O, Danino AM, Malka G. Dynamic external traction system for management of distal displaced fractures of the head of the proximal phalanx. Chir Main. 2007;26:21-5.

Shrestha BR, Lama S, Shrestha U. Ultrasound Guided Stellate Ganglion Block with Dexmedetomidine as an Adjuvant in Complex Regional Pain Syndrome (CRPS). Kathmandu Univ Med J (KUMJ). 2021;19(73):148-51.

Ellis PR, Tsai TM. Management of the traumatized joint of the finger. Clin Plast Surg. 1989;16:457-73.

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Published

2023-01-16

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Original Research Articles