Fractures involving the base of the middle phalanx with proximal interphalangeal (PIP) joint subluxation represent complex intra-articular injuries that, if improperly managed, can lead to stiffness, joint incongruity, and functional impairment. These injuries typically involve the volar lip of the middle phalanx, resulting in dorsal subluxation due to extensor pull and loss of volar buttress ^[1]. Conventional treatments, including K-wire fixation, volar plate open reduction and internal fixation (ORIF), and static external fixators, are associated with varying degrees of post-operative stiffness and prolonged immobilization ^[2]. The Suzuki frame, described in 1994, uses dynamic distraction through skeletal fixation to maintain alignment while allowing early joint motion ^[3]. Although promising, there is a lack of high-quality comparative data against established methods. This report presents a case treated with the Suzuki frame and highlights technical considerations, rehabilitation, and the need for standardized evaluation.

A 37-year-old right-handed male presented with pain, swelling, and deformity of the left index finger after a cricket injury. Physical examination showed diffuse swelling, flexion deformity at the PIP joint, and tenderness (Fig. 1). No neurovascular deficits were identified.

Radiographs revealed a comminuted fracture at the base of the middle phalanx with dorsal subluxation. The injury was treated with a Suzuki frame comprising the following:

• 1.2 mm axial traction pin through the proximal phalanx head
• 1 mm hook pin through the distal middle phalanx
• 1.2 mm reduction pin dorsal to the fracture site.

Sterile intravenous tubing was used to provide adjustable dynamic tension. Intraoperative fluoroscopy confirmed alignment. A post-operative structured hand therapy protocol was initiated under physiotherapy guidance, including passive and active range-of-motion exercises starting within the 1^st week (Fig. 2-4).

Follow-up at 6 weeks showed radiographic healing and maintained joint congruity (Fig. 5). By 3 months, the patient had regained >90% of active PIP motion. At 6 months, radiographs confirmed complete union. The patient reported minimal pain on the Visual Analog Scale (VAS) (VAS = 1/10), high satisfaction, and resumed work by the 8^th week. Functional recovery was assessed using the total active motion score, with near-normal values ^[4] (Fig. 6-8).

The Suzuki frame permits dynamic stabilization with early mobilization, reducing the risk of joint contracture seen in static fixation. By preserving joint motion, it supports cartilage healing and facilitates better long-term outcomes ^[5]. Compared to ORIF, K-wire fixation, or mini external fixators, it is minimally invasive and requires fewer surgical instruments ^[6]. Technical considerations, such as accurate pin placement, tension calibration, and consistent follow-up are critical for successful outcomes ^[7]. Rehabilitation plays a pivotal role and must be tailored to ensure joint mobility and prevent stiffness ^[8]. While the technique has shown success in this case, it should be noted that a single case lacks statistical power. The absence of a control group, limited follow-up, and reliance on radiography without advanced imaging are notable limitations. Potential complications, including pin site infection, extensor tendon irritation, and wire migration, must be anticipated and managed with proper technique and patient education ^[9]. Comparative cost-analysis data were not collected, although the frame’s simplicity suggests resource efficiency. Future investigations should include validated outcome scores, longer follow-up, and cost-benefit analyses ^[10].

The Suzuki frame provides a viable option for intra-articular phalanx fractures with dorsal subluxation, combining simplicity, cost-efficiency, and functional preservation. However, larger comparative studies using validated outcome tools and longer follow-up are needed to establish its efficacy over standard techniques.

The Suzuki frame enables dynamic and stable fixation for complex finger fractures, ensuring early joint mobilization and good recovery. Successful outcomes depend on meticulous technique, structured rehabilitation, and patient compliance, and should be measured using objective scoring systems.