Suzuki's pins and rubber traction for fractures of the base of the middle phalanx

Abstract

Basal fractures of the middle phalanx are uncommon, but difficult to treat. We have reviewed our first 20 patients using the Suzuki pins and rubber traction who were treated during an 8.5 year period (June 1998-December 2006) and 18 who were reviewed after 49 (range 17-116) months. All injuries were closed fractures of the base of the middle phalanx. Ten patients had a fracture of the volar lip and dorsal subluxation of the phalanx, one had a fracture of the dorsal lip, and seven had comminuted pilon fractures. Median operating time was 33 (18-255) minutes. Thick "vessel loops" were often used for traction, and active movement before the traction was removed after 38 (8-46) days was disappointing. There were two superficial infections and one deep. One proximal interphalangeal (PIP) joint had been treated by arthrodesis and another amputated before review. On a visual analogue scale (VAS) from 0 (best) to 10 (worst), patients at review reported discomfort when wearing the traction as 5.5 (0-10), pain as 0 (0-6), and finger function as 3 (0-6). The median Quick-DASH score (100 = worst) was 2 (0-48) and grip strength 97 (75-118) % of the other hand. Median extension, flexion, and total range of movement of the PIP joint in 16 fingers were -9°, 83°, and 72°, respectively. Our results are no more than adequate. They might have been better if the force of traction had been less by using rubber bands instead of vessel loops, if postoperative follow-up had been more frequent allowing for correction of traction when necessary, and if traction had been discontinued earlier.

Treatment of proximal interphalangeal joint fractures by the pins and rubbers traction system: a follow-up

“…We found that the volar lip fractures were most frequent, which are in agreement with previously published papers [12,13]. Most fractures occurred during sports and men were more predominately injured (male:female ratio of 1.8) [5,12,[14][15][16].…”

“…ADL status from the objective evaluation resulted in the low score of one, which supports such a notion. Grip and pinch strength (93% and 100%, respectively) are also important markers of function and were as high in this study as in others [13,14,16,18,19]. Unfortunately, the objective evaluation only included 18 patients, which can account for the low TAM.…”

“…Radiological signs of posttraumatic osteoarthritis were found in 61%, where all three dorsal lip fractures showed signs of posttraumatic osteoarthritis. Arthrodesis or PIP joint prosthesis was rare, which is also the experience of other authors [6,13,16]. However, although 61% (25/41) showed radiological signs of osteoarthritis, the results from the subjective evaluation showed that most patients did not suffer from symptoms of osteoarthritis (i.e.…”

“…The most frequent reasons for early extraction were signs of infection or loose pins. The patients had seven (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) outpatient visits with a surgeon. The number of outpatient visits with a hand therapist was six (0-20).…”

Manejo de la fractura-luxación Interfalángica proximal mediante fijador externo tipo Suzuki. Protocolo de tratamiento y resultados preliminares

“…En esta serie se obtiene un rango articular satisfactorio (90°de media), que está en consonancia con lo descrito en la literatura tanto por fijadores externos similares como el de Shen y col., 25 (83,9°), Finsen y col., 27 (72°) o Ruland y col., 28 (88°) así como por otros fijadores prefabricados como el de Kodama y col (91,2°), MacFarlane y col (85°) y Pélissier y col., (70°) 16,24,29 y es superior a otras publicaciones en las que se llevó a cabo cirugía abierta, como la de Cheah y col., 9 (75°).…”