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

Background: Reduction of some modified Gartland type III and IV supracondylar humerus fractures can pose difficulties, especially if they present late to the hospital. Various techniques of reduction have been tried for reducing the supracondylar humerus fracture for sagittal and coronal plane correction. This retrospective study assesses the dual joystick technique's possible effectiveness in achieving an anatomical reduction of the supracondylar humerus fracture.

Methods: Patients with modified Gartland's type III and IV supracondylar humerus fractures who underwent closed reduction and percutaneous pinning using the dual joystick technique at our trauma center between January 2020 and January 2022 were the subject of a retrospective review. Forty-six patients treated by the above technique who met the inclusion criteria were analyzed at the end of the final follow-up.

Results: The mean age of the children was 7.9+/- 2.25 years, with a male predominance at 32:14. The Right upper limb was more involved compared to the left side. The mean injury to hospital presentation was 2.67+/- 1.28 days, and the mean surgical duration was 24.57+/- 13.76 minutes. The average pin spread ratio at the fracture site was 35.17+/- 3.04%. Baumann angle at the final follow-up was 74.83+/- 2.56 degrees. The mean lateral rotation percentage was 2.8+/- 1.3%. 39 patients had excellent cosmetic outcomes, and 42 had excellent functional outcomes, whereas 7 and 4 patients had good cosmetic and functional outcomes, respectively, according to Flynn criteria.

Conclusions: In modified Gartland type III and IV fractures with late presentation where reduction is challenging, this technique is shown to be convenient and easily reproducible and helps accomplish near anatomical reduction with reduced lateral rotation percentage and results in excellent to good outcomes.