A Rare and Unique Complication of Pins and Rubbers Traction System (Suzuki frame) while Managing Simple PIPJ Fracture-dislocation

Abstract

Introduction: The management of acute proximal interphalangeal (PIP) joint fracture-dislocation by dynamic external fixator is widely practiced method. The complications such as pin loosening or non-union or stiffness are known and can be treated well. The over distraction causing vascular compromise and calcification of volar plate jeopardizing the function and viability of the affected digit is not reported so far. Case Report: We report a case of 2 weeks post-traumatic ring finger PIP joint fracture-dislocation in a 21-year-old male which was treated by pins and rubber dynamic traction method. The affected digit was found cold and lengthened at 3 weeks of distraction causing vascular compromise. The X-ray showed over distraction by 1.5 cm at PIP joint. The digit was salvaged by removing distractor and applying splintage. Later, at 6 weeks, X-ray showed volar plate calcification causing joint stiffness. This was tackled by volar plate arthroplasty. At 2 months, the patient got 20–80° movement without pain. Conclusion: The dynamic pins and rubber traction system for acute PIP joint injury can result in complication like over distraction leading vascular compromise. The clinical and radiological assessment with such technique is mandatory once a week to avoid missing such disasters. Even if such complication occurs, immediate fixator removal and splintage can save the digit. Once it survives, secondary procedure for gaining movement or stabilizing the joint like volar plate arthroplasty can be considered. Keywords: Pins and Rubbers traction system, Over distraction, Vascular compromise

Results of an Adjustable Traction Method Using Surgical Gloves and K-Wires for the Treatment of Proximal Interphalangeal Joint Fracture Dislocation

“…By contrast, other methods adjust the force by adding rubber bands, which does not allow seamless fine-force tuning. For example, although it was reported that overdistraction leads to vascular compromise in the case of dynamic pins and rubber systems for acute PIP joint injuries, 10 the wire-frame traction method allows for delicate adjustments, which helps avoid such complications. Moreover, adjustments can be made to the radial and ulnar sides.…”