DYNAMIC EXTERNAL FIXATION USING SUZUKI FRAME FOR MIDDLE PHALANX BASE FRACTURE WITH ASSOCIATED MALLET FRACTURE OF THE INDEX FINGER: A CASE REPORT

Abstract

Background: A combined injury pattern involving a bony mallet fracture at the distal interphalangeal (DIP) joint and an intra-articular fracture of the base of the middle phalanx associated with dorsal subluxation of the proximal interphalangeal (PIP) joint is rarely encountered. The involvement of two adjacent finger joints makes restoration of alignment and early functional recovery particularly challenging. Inadequate reduction and prolonged immobilization can lead to extensor lag, joint stiffness, persistent pain, and post-traumatic arthritis. The Suzuki dynamic external fixation system provides a minimally invasive approach to maintain PIP joint reduction while facilitating early mobilization. Case Report: A 36-year-old male presented with pain, swelling, and deformity of the left index finger following trauma while playing cricket. Radiographs revealed a bony mallet fracture involving the distal phalanx and an intra-articular middle phalanx base fracture with dorsal PIP joint subluxation. The patient underwent K-wire fixation for the mallet fracture and Suzuki frame dynamic external fixation for the PIP fracture-dislocation. Early active motion was initiated postoperatively. Results: At six weeks, radiological union and maintenance of reduction were observed. At three months, the patient achieved PIP flexion greater than 90°, extensor lag less than 5°, painless grip function, and return to pre-injury activities. Conclusion: This case highlights the unusual presentation of simultaneous bony mallet injury with proximal interphalangeal joint fracture dislocation in the same digit. Hybrid fixation using k wire pinning and Suzuki frame dynamic external fixation is an effective treatment option for combined DIP and PIP joint injuries. It provides stable fixation, allows early mobilization, and yields good functional outcomes.