Abstract
We present a case of an unstable proximal interphalangeal fracture of the fifth finger. We want to review the treatment of this entity, by using a dynamic external distractor designed from the Suzuki frame; we recommend this technique to young orthopaedic surgeons.
Citation
Boussakri H, Elibrahimi A and Elmrini A. Dynamic Distraction External Fixation Derived from the SUZUKI Frame for Pip Joint Fractures. SM J Orthop. 2015;1(5):1025
Letter to the Editor
We present a case of an unstable proximal interphalangeal fracture of the fifth finger. We want to review the treatment of this entity, by using a dynamic external distractor designed from the Suzuki frame; we recommend this technique to young orthopaedic surgeons.
Mr.AM:21 years old, right-handed, a manual worker, who consults for pain and inability to flex the PIP joint of the fifth finger, which occurred after accidentally punching a wall. Initial X-ray of the front and side if the hand showed a comminuted fracture of the PIP joint. Further investigation for a precise evaluation of injury was performed using a CT scan with reconstruction (Figure 1).
Figure 1: X-ray and CT scan of the PIP fracture.
Our choice of treatment was surgery. We opted for a Suzuki dynamic external fixation (1994). This surgery was performed under local anesthesia (Figure 2)
Figure 2: Clinical appearance after dynamic external fixation
and (Figure 3).
Figure 3: Intraoperative X-ray image of the fracture.
The procedure was completed by a well-conducted gentle reduction of the joint. Follow up in the eighth month was satisfactory with the patient having a normal mobility of the joint compared to his other hand. The patient was able to resume his daily activity without disabilities.
Fractures of the proximal interphalangeal joint are complex [1]. Stable fractures of this joint must be must differentiated from unstable fractures. Unstable fractures must be securely fixed to avoid any immobilization of the PIP joint. This trauma is characterized by an extreme pathological variety, as well as difficulties in dealing with the risk of stiffness, instability and osteoarthritis. These fractures weigh heavily on the ability entire finger and the overall function of the hand.
Therapeutic management of this trauma remains a subject of debate and scientific discussion. Several surgical techniques that respect the anatomical features of this region have since been proposed. Two basic surgeries have been described i.e. open reduction or external fixation. Each has its own anatomical basis and biomechanical prerequisites.
We report our experience with a designed dynamic external distractor derived from the Suzuki frame through this case report craft. The philosophy and the concept of dynamic external distraction is based on external fixation of the fracture (ligamentotaxis) using a simple and relatively cheap material like two Kirchner wires and rubber bands. This system has been well studied and detailed by Suzuki [2] (Figure 4).
Figure 4: Diagram shows the biomechanics of dynamic external fixator.
The review of the literature found few studies which evaluate this original chirurgical technique. We conducted our research on PUBmed, Google scholar, using keywords; Suzuki traction, articular fracture, PIP joint, finger [2-6]. However, this technique remains a choice in our personal experience. We will like to note that prospective series of 10 cases is ongoing for our personal long-term evaluation of this technique
The designed dynamic external distractor derived from the Suzuki frame is light to wear for the patient, it is simple to produce and thus can be easily taught to younger surgeons.
Acknowledgement
Dr Tenkorang Snr Somuah contributed immensely towards the redaction of this article in English and made substantial contributions to its conception.