Title : Suzuki frame fixation in Proximal Interphalangeal Joint (PIPJ) fractures: Systematic review and meta-analysis
Abstract:
Background: The Suzuki frame is a commonly used dynamic external fixation system used to manage complex intra-articular fractures of digits, particularly in Proximal InterPhalangeal Joint (PIPJ) injuries. This technique utilises Kirschner wires and elastic rubber bands to create controlled traction, whilst permitting fracture reduction and early mobilisation following injury. These factors provide superior stabilisation of fracture fragments than other techniques such as buddy taping and casting, is less invasive than open reduction and internal fixation and avoids long-term complications from retained metalwork. We present the first systematic review and meta-analysis that studies the postoperative function of patients treated with Suzuki frame fixation and measures rates of complications.
Methods: A meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies that assessed the functional or clinical outcome of the Suzuki frame in the management of intra-articular PIPJ fractures of the index, middle, ring and little fingers were included. There was no restriction on age, sex, comorbidities, acuity of injury or fracture pattern. Open Meta[Analyst] software was used to conduct data synthesis and generate forest plots reported at 95% confidence intervals (CI). Functional parameters were comprised of PIPJ flexion, extension, overall range of motion, percentage grip strength and Disabilities of the Arm, Shoulder and Hand score. In addition, the range of motion was compared between patients in which the Suzuki frame was applied either within 7 days of injury or after.
Results: 22 studies involving 332 fractures were included from 161 articles. Functional outcomes following Suzuki frame application showed mean range of motion of 83.0 degrees (CI 76.6 - 89.4, p < 0.001), mean flexion of 87.2 degrees (CI 83.8 - 90.7, p < 0.001), mean extension 7.5 degrees (CI 5.0 - 10.0, p < 0.001), percentage grip strength 91.7 % (CI 90.1 - 93.4, p < 0.001) and Disabilities of the Arm, Shoulder and Hand score of 3.7 (CI 2.6 - 4.7, p < 0.001). There was no significant difference in range of motion between application of the Suzuki frame before or after 7-days of injury (mean ROM 20.4 degrees, CI -20.0 - 60.8, p = 0.0322). Documented complications included clinodactyly, arthritis, pin-site infection, reduced joint mobility, pin-site loosening, osteomyelitis and complex regional pain syndrome.
Conclusion: Suzuki frame fixation of PIPJ injuries enable satisfactory functional outcomes with an acceptable rate of complications. Additionally, there was no significant difference in final range of motion when treatment was initiated within or beyond seven days post-injury. Our study was solely based on cohort data. In the future, high-quality randomised controlled trials with extended follow-up periods and standardised outcome measures are warranted to better define the role of Suzuki frame fixation and compare its efficacy against alternative techniques.
