Modified Suzuki Frame Fixation for the Treatment of Dorsal Proximal Interphalangeal Joint Fracture-Dislocation

The proximal interphalangeal (PIP) joint is critical for hand function, contributing substantially to grasping and overall dexterity^1-3. Injuries to this joint, often caused by axial loading, can lead to various fracture patterns and dislocations, resulting in long-term complications such as pain, stiffness, reduced range of motion, arthritis, and instability^1,2. Traditional surgical approaches for unstable dorsal PIP joint fracture-dislocation include dorsal block pinning, open reduction and internal fixation (ORIF), hemi-hamate or hemi-capitate arthroplasty, and external fixation^1-3. Although these methods can be effective, they may have limitations in certain situations. The Suzuki frame, a pins-and-rubber-band traction system, offers a dynamic external fixation option that allows for early controlled motion while maintaining fracture reduction. This technique has several advantages, including ligamentotaxis (the traction force helps to reduce fracture fragments and restore joint alignment), early mobilization (the dynamic nature of the frame allows for early active motion, minimizing joint stiffness), and simplicity (the technique is relatively straightforward and can be performed with readily available materials).

The modified Suzuki frame procedure for dorsal PIP joint fracture-dislocation involves administering local anesthesia and establishing a sterile field. Under fluoroscopic guidance, three 1.0-mm Kirschner wires are inserted: 1 through the center of rotation of the proximal phalangeal head, 1 through the center of rotation of the middle phalangeal head, and 1 (the "translation pin") in the middle phalanx distal to the fracture. The wires are then bent to create a frame with hooks, and the translation pin is secured to the proximal wire. Rubber bands are applied between the hooks to provide traction and maintain reduction. PIP joint congruency is confirmed through a full range of motion under fluoroscopy. Dressings and a splint are applied, allowing for limited immediate postoperative motion. Formal hand therapy begins 1 week postoperatively.

Although nonsurgical treatment may be considered for stable, minimally displaced dorsal PIP joint fracture-dislocations, unstable injuries often necessitate operative intervention to restore joint congruity and stability. Several surgical techniques are available to treat these injuries, each with its own advantages and limitations. These techniques include dorsal block pinning, ORIF, hemi-hamate or hemi-capitate arthroplasty, and the use of modified external fixators with various external fixation constructs and pins to provide stability and allow for early controlled motion.

The modified Suzuki frame is a dynamic external fixator that addresses the limitations of other treatment options for dorsal PIP joint fracture-dislocation. The modified Suzuki frame provides distraction, ligamentotaxis, and a volar-directed force while allowing early range of motion, preventing stiffness, and promoting cartilage healing^1,2. This technique dynamically adjusts traction, unlike the use of static fixation, and is less invasive than ORIF, preserving joint anatomy that is crucial for younger patients. Use of the modified Suzuki frame is also simpler than that of traditional external fixators, making it ideal for complex fractures, soft-tissue injuries, and early mobilization^1-3.

The modified Suzuki frame is designed to stabilize finger fractures while permitting early mobilization during the healing process. This approach helps reduce stiffness and increases the likelihood of regaining full finger function. Dynamic external fixation of this type has been shown to be highly effective for complex PIP joint injuries. Suzuki et al. reported that patients achieved an average range of motion of 80° at the PIP joint¹. Ellis et al. demonstrated comparable outcomes, with patients achieving an average range of motion from 1° to 89°². With appropriate care and diligent rehabilitation, patients can generally expect to regain satisfactory motion and function of the injured finger. Continuous monitoring and structured exercise programs are recommended to support optimal recovery outcomes.

This technique is best suited for unstable dorsal PIP joint fracture-dislocations that are reducible with traction or translation.Accurate pin placement is crucial for optimal results. Utilize fluoroscopy to confirm pin position and avoid injury to the surrounding structures.Ensure adequate traction with the rubber bands to maintain fracture reduction and joint alignment.Utilize sharp, double-ended Kirschner wires of approximately 15 cm (6 in) and 23 cm (9 in).Bend the wires carefully to create secure hooks and avoid sharp edges that could irritate the skin.Maintain approximately 2.5 cm (1 in) between the proximal and distal hooks to ensure adequate stability.Pin-site infection is a potential complication. Emphasize proper pin care to patients.Kirschner wire migration or breakage can occur. Monitor pin sites regularly and address any issues promptly.Excessive traction can lead to distraction of the fracture or joint. Adjust the rubber bands as needed to maintain appropriate tension.Achieving and maintaining adequate reduction in complex fracture patterns can be challenging.Balancing stability and motion requires careful adjustment of the frame and rubber band tension.Patient compliance with pin care and rehabilitation protocols is essential for optimal outcomes.

K-wire = Kirschner wire.