Double joystick technique – a modified method facilitates operation of Gartlend type-Ⅲ supracondylar humeral fractures in children

Abstract

Gartland type-Ⅲ supracondylar humerus fracture (SCHF) is a severe lesion with the feature of difficult reduction. Due to the high failure rate of traditional reduction, a more practical and safer method is needed. This retrospective study aimed to explore the effectiveness of the double joystick technique during the closed reduction of children with type-III fractures. Forty-one children with Gartland type-Ⅲ SCHF underwent closed reduction and percutaneous fixation using the double joystick technique at our hospital between June 2020 and June 2022, and 36 (87.80%) patients were successfully followed up. The affected elbow was evaluated by the joint motion, radiographs, and Flynn's criteria then contrasted with the contralateral elbow at the last follow-up. A group of 29 boys and seven girls with an average age of 6.33 ± 2.68 years. The mean time of surgery and hospital stay was 26.61 ± 7.51 min and 4.64 ± 1.23 days, respectively. After a mean follow-up of 12.85 months, the average Baumann angle was 73.43 ± 3.78°, although the average carrying angle (11.33 ± 2.17°), flexion angle (143.03 ± 5.15°), and extension angle (0.89 ± 3.23°) of the affected elbow were less than those of the contralateral elbow (P < 0.05), the mean range of motion difference between two sides is only 3.39 ± 1.59°, with no complications. Furthermore, 100% of patients recovered satisfactorily, with excellent outcomes (91.67%) and good outcomes (8.33%). The double joystick technique is a safe and effective method that facilitates the closed reduction of Gartland type-Ⅲ SCHF in children without raising the risk of complications.

Dual Joystick Technique for Reduction of Torsional Profile in Pediatric Supracondylar Humerus Fracture With Delayed Presentation

“…He further described the position of the proximal pin to avoid neurological injury, which was achieved by inserting the pin in the lateral supracondylar ridge at the most proximal part 13 . Recently, a double joystick technique with one K wire in the proximal fragment close to fracture and another transolecranon K wire for correction of the angulation, which was described by Li et al 14 was found to be the most effective among the above-described techniques in terms of fracture reduction. Despite various techniques described we still found persistence of lateral rotation of the fragment postfixation.…”

A simple but useful technique using artery forceps for reduction of difficult Type III supracondylar fractures in children: A descriptive study

“…Closed reduction and percutaneous pinning (CRPP) is a gold standard technique for displaced Gartland type III supracondylar fractures of humerus in children and key point is to get the satisfactory reduction for optimal outcomes after surgery 1,2 . However, it is sometimes very difficult to have satisfactory closed reduction and may require open reduction and Kirschner (K wire) fixation which is inherently associated with a number of complications 3,4,5 .This technique, where artery forceps is inserted into the fracture site through a small nick in skin which helps to reduce the distal fragment by levering the artery forceps at proximal fragment, is a simple, reliable and very effective technique for reduction of complicated type III supracondylar fracture of humerus in children which otherwise requires open reduction and fixation.…”