Clinical Outcomes and Complications of the Suzuki Frame in Digital Fractures: A Systematic Review and Meta-Analysis

Intraarticular fractures of the phalanges and thumb base are challenging to manage due to the risks of stiffness and loss of motion. The Suzuki pins and rubbers traction system provides dynamic external fixation that maintains reduction while allowing early mobilisation. No prior systematic review and meta-analysis (SRMA) has comprehensively evaluated its outcomes. This study aimed to summarise radiographic union, functional recovery and complication rates to inform clinical decision-making. In accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines, MEDLINE and Embase were searched from 1994 to October 2025. Eligible studies included ≥5 patients with intraarticular phalangeal or thumb fractures managed using the Suzuki frame. Primary outcomes included range of motion (ROM), union rate and grip strength. Data extraction was performed in Microsoft Excel (Microsoft Corporation, Redmond, WA, US), screening in Rayyan and analysis in OpenMetaAnalyst, using fixed or random effect models with 95% CIs and Cochran's Q and I² tests. Twelve studies (183 patients, 185 fractures) were included in the analysis. The pooled union rate was 97.8% (95% CI 0.95 - 1.00, p<0.001). Functional recovery was favourable; pooled proximal interphalangeal joint (PIPJ) range of motion (RoM) was 89.6 degrees (95% CI 88.4 - 90.7, p<0.001). Distal interphalangeal joint (DIPJ) ROM was 66.0 degrees (95% CI 64.6 - 67.4, p<0.001), and grip strength was 81.2% (95% CI 78.3 - 84.0, p<0.001). Pin site infection rate was 10.3% (95% CI 0.0 - 0.2, p<0.001), and joint space narrowing was 5% (95% CI 0.0 - 0.1, p<0.05). Post-traumatic arthritis occurred in 2.7%. Pain was minimal (visual analogue scale (VAS) <2). The Suzuki traction system achieves high union, satisfactory ROM and low complication rates in intraarticular digital fractures. Maintaining traction for four to six weeks optimises healing. Its minimally invasive design enables early motion and supports functional recovery and quality of life.