Effectiveness of double joystick technique assisted treatment of Gartland type <b>Ⅲ</b> supracondylar fractures of the humerus in children_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Guangyao ¹ , HU Feng ¹ , BAI He ¹ , LIU Wei ¹ , HAN Dandan ¹ , CHEN Quangui ¹ , TAN Shaolin ¹ ,  SHA Ke ²

1. Department of Orthopedics, the Second Affiliated Hospital of Guangxi Medical University, Nanning Guangxi, 530021, P. R. China;
2. Department of Traumatic Orthopedics Hand Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning Guangxi, 530021, P. R. China;

Corresponding?author：

SHA Ke, Email: shake68@126.com

Keywords：

Double joystick technique; supracondylar fractures of the humerus; closed reduction; child

DOI：

10.7507/1002-1892.202505080

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Objective To evaluate the effectiveness of double joystick technique assisted closed reduction and Kirschner wire internal fixation in the treatment of Gartland type Ⅲ supracondylar fractures of the humerus (SCFH) in children. Methods A retrospective study was conducted on 28 cases of Gartland type Ⅲ SCFH with complete data available, who underwent closed reduction and Kirschner wire internal fixation with the double joystick technique between August 2022 and July 2024. There were 23 boys and 5 girls, with an average age of 6.4 years (range, 1-12 years). All fractures resulted from falls and were classified as extension-type. X-ray film showed the radial displacement of the distal fragment in 15 cases and unlar displacement in 13 cases. The interval from injury to operation was 3-36 hours (mean, 19.5 hours). X-ray film re-examination was conducted to evaluate the fracture healing, and the Baumann angle of affected elbow joint and carrying angle of bilateral elbow joints were measured. Elbow joint function was evaluated using the range of motion (flexion and extension) and the Flynn criteria. The above indicators were compared between affected and healthy sides. Results All operation were successfully completed. The operation time ranged from 15 to 40 minutes (mean, 25.2 minutes). The length of hospital stay was 2-5 days (mean, 3.5 days). All patients were followed up 3-24 months (mean, 11.8 months). X-ray film confirmed fracture healing in all patients, with a mean healing time of 5.4 weeks (range, 4-6 weeks). At last follow-up, the Baumann angle of the affected elbow joint was (73.50±3.46)°, and the carrying angle and the range of motion in flexion and extension of the affected elbow joint were significantly less than the contralateral side (P<0.05). According to the Flynn criteria, the elbow joint function of the affected elbow was evaluated as excellent in 25 cases and good in 3 cases, with an excellent and good rate of 100%. Conclusion The double joystick technique is a safe and effective method which can facilitate the closed reduction and Kirschner wire internal fixation of Gartland type Ⅲ SCFH in children without increasing risk of complications.

Citation： LI Guangyao, HU Feng, BAI He, LIU Wei, HAN Dandan, CHEN Quangui, TAN Shaolin, SHA Ke. Effectiveness of double joystick technique assisted treatment of Gartland type Ⅲ supracondylar fractures of the humerus in children. Chinese Journal of Reparative and Reconstructive Surgery, 2025, 39(9): 1160-1164. doi: 10.7507/1002-1892.202505080 Copy

1.	Ali S, Kumar S, Nath R, et al. Prospective study of functional and radiological outcome after operative management of supracondylar fracture humerus in children. J Orthop Case Rep, 2025, 15(3): 257-264.
2.	Gartland JJ. Management of supracondylar fractures of the humerus in children. Surg Gynecol Obstet, 1959, 109: 145-154.
3.	Hasan SU, Pervez A, Usmani SUR, et al. Comparative analysis of pinning techniques for supracondylar humerus fractures in paediatrics: A systematic review and meta-analysis of randomized controlled trials. J Orthop, 2023, 44: 5-11.
4.	Suganuma S, Tada K, Takagawa S, et al. Independent predictors affecting the reduction of pediatric supracondylar humerus fractures: a retrospective cohort study. Eur J Orthop Surg Traumatol, 2021, 31(2): 399-406.
5.	韋宜山, 劉萬林, 崔鵬飛, 等. 尺骨鷹嘴穿針操縱桿技術輔助治療兒童多方向不穩定肱骨髁上骨折的對比研究. 中華小兒外科雜志, 2020, 41(6): 542-549.
6.	馬海龍, 劉方, 周志林, 等. 克氏針重建內, 外側柱骨膜鉸鏈輔助兒童多方向不穩定肱骨髁上骨折閉合復位的療效研究. 中國修復重建外科雜志, 2023, 37(10): 1220-1224.
7.	劉旭, 吳偉, 單宇宙, 等. 極度屈肘位下肘橫紋延長線在兒童伸直型肱骨髁上骨折尺側置針定位中的應用. 中國修復重建外科雜志, 2025, 39(1): 70-74.
8.	Flynn JC, Matthews JG, Benoit RL. Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen years’ experience with long-term follow-up. J Bone Joint Surg (Am), 1974, 56(2): 263-272.
9.	Wang Y, Chong Q, Zhang S, et al. Analysis of risk factors for failed closed reduction in pediatric Gartland type Ⅲ supracondylar humerus fracture. J Shoulder Elbow Surg, 2024, 33(10): 2279-2289.
10.	British Orthopaedic Association Trauma Committee. Supracondylar fractures of the humerus in children. Injury, 2021, 52(3): 376-377.
11.	Kumar V, Singh A. Fracture supracondylar humerus: A review. J Clin Diagn Res, 2016, 10(12): RE01-RE06.
12.	文玉偉, 王強, 宋寶健, 等. 閉合復位與橈側交叉克氏針治療兒童Gartland Ⅲ型肱骨髁上骨折. 中華小兒外科雜志, 2020, 41(9): 824-830.
13.	DiBartola AC, Thakur N, Singh S, et al. Do obese children have poor patient-reported outcomes after closed reduction and percutaneous pin fixation of supracondylar humerus fractures? J Pediatr Orthop, 2021, 41(4): e337-e341.
14.	潘天龍, 侯相華, 張敬東. 手術時機對閉合復位經皮克氏針內固定術治療兒童肱骨髁上骨折療效影響的研究. 中國修復重建外科雜志, 2025, 39(5): 569-573.
15.	褚祥軍, 孫軍, 劉永, 等. 兒童肱骨髁上骨折閉合復位失敗的處理與因素. 中國矯形外科雜志, 2022, 30(12): 1076-1080.
16.	Novais EN, Andrade MA, Gomes DC. The use of a joystick technique facilitates closed reduction and percutaneous fixation of multidirectionally unstable supracondylar humeral fractures in children. J Pediatr Orthop, 2013, 33(1): 14-19.
17.	Dong L, Wang Y, Qi M, et al. Auxiliary Kirschner wire technique in the closed reduction of children with Gartland type Ⅲ supracondylar humerus fractures. Medicine (Baltimore), 2019, 98(34): e16862. doi: 10.1097/MD.0000000000016862.
18.	Wei YS, Liu WL, Bai R, et al. The use of a transolecranon pin joystick technique in the treatment of multidirectionally unstable supracondylar humeral fractures in children. J Pediatr Orthop B, 2020, 29(5): 452-457.
19.	Wang SB, Lin BH, Liu W, et al. Modified closed reduction and percutaneous Kirschner wires internal fixation for treatment of supracondylar humerus fractures in children. Curr Med Sci, 2021, 41(4): 777-781.
20.	Yousri T, Tarassoli P, Whitehouse M, et al. Systematic review of randomized controlled trials comparing efficacy of crossed versus lateral K-wire fixation in extension type Gartland type Ⅲ supracondylar fractures of the humerus in children. Ortop Traumatol Rehabil, 2012, 14(5): 397-405.
21.	Li J, Rai S, Tang X, et al. Surgical management of delayed Gartland type Ⅲsupracondylar humeral fractures in children: A retrospective comparison of radial external fixator and crossed pinning. Medicine (Baltimore), 2020, 99(10): e19449. doi: 10.1097/MD.0000000000019449.
22.	黃晉, 羅鵬飛, 劉春娥. 手法閉合復位配合兩種克氏針固定方式治療GartlandⅡ型和Ⅲ型兒童肱骨髁上骨折療效比較. 中國骨傷, 2020, 33(10): 895-902.
23.	Li M, Xu J, Hu T, et al. Surgical management of Gartland type Ⅲ supracondylar humerus fractures in older children: a retrospective study. J Pediatr Orthop B, 2019, 28(6): 530-535.

1. Ali S, Kumar S, Nath R, et al. Prospective study of functional and radiological outcome after operative management of supracondylar fracture humerus in children. J Orthop Case Rep, 2025, 15(3): 257-264.
2. Gartland JJ. Management of supracondylar fractures of the humerus in children. Surg Gynecol Obstet, 1959, 109: 145-154.
3. Hasan SU, Pervez A, Usmani SUR, et al. Comparative analysis of pinning techniques for supracondylar humerus fractures in paediatrics: A systematic review and meta-analysis of randomized controlled trials. J Orthop, 2023, 44: 5-11.
4. Suganuma S, Tada K, Takagawa S, et al. Independent predictors affecting the reduction of pediatric supracondylar humerus fractures: a retrospective cohort study. Eur J Orthop Surg Traumatol, 2021, 31(2): 399-406.
5. 韋宜山, 劉萬林, 崔鵬飛, 等. 尺骨鷹嘴穿針操縱桿技術輔助治療兒童多方向不穩定肱骨髁上骨折的對比研究. 中華小兒外科雜志, 2020, 41(6): 542-549.
6. 馬海龍, 劉方, 周志林, 等. 克氏針重建內, 外側柱骨膜鉸鏈輔助兒童多方向不穩定肱骨髁上骨折閉合復位的療效研究. 中國修復重建外科雜志, 2023, 37(10): 1220-1224.
7. 劉旭, 吳偉, 單宇宙, 等. 極度屈肘位下肘橫紋延長線在兒童伸直型肱骨髁上骨折尺側置針定位中的應用. 中國修復重建外科雜志, 2025, 39(1): 70-74.
8. Flynn JC, Matthews JG, Benoit RL. Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen years’ experience with long-term follow-up. J Bone Joint Surg (Am), 1974, 56(2): 263-272.
9. Wang Y, Chong Q, Zhang S, et al. Analysis of risk factors for failed closed reduction in pediatric Gartland type Ⅲ supracondylar humerus fracture. J Shoulder Elbow Surg, 2024, 33(10): 2279-2289.
10. British Orthopaedic Association Trauma Committee. Supracondylar fractures of the humerus in children. Injury, 2021, 52(3): 376-377.
11. Kumar V, Singh A. Fracture supracondylar humerus: A review. J Clin Diagn Res, 2016, 10(12): RE01-RE06.
12. 文玉偉, 王強, 宋寶健, 等. 閉合復位與橈側交叉克氏針治療兒童Gartland Ⅲ型肱骨髁上骨折. 中華小兒外科雜志, 2020, 41(9): 824-830.
13. DiBartola AC, Thakur N, Singh S, et al. Do obese children have poor patient-reported outcomes after closed reduction and percutaneous pin fixation of supracondylar humerus fractures? J Pediatr Orthop, 2021, 41(4): e337-e341.
14. 潘天龍, 侯相華, 張敬東. 手術時機對閉合復位經皮克氏針內固定術治療兒童肱骨髁上骨折療效影響的研究. 中國修復重建外科雜志, 2025, 39(5): 569-573.
15. 褚祥軍, 孫軍, 劉永, 等. 兒童肱骨髁上骨折閉合復位失敗的處理與因素. 中國矯形外科雜志, 2022, 30(12): 1076-1080.
16. Novais EN, Andrade MA, Gomes DC. The use of a joystick technique facilitates closed reduction and percutaneous fixation of multidirectionally unstable supracondylar humeral fractures in children. J Pediatr Orthop, 2013, 33(1): 14-19.
17. Dong L, Wang Y, Qi M, et al. Auxiliary Kirschner wire technique in the closed reduction of children with Gartland type Ⅲ supracondylar humerus fractures. Medicine (Baltimore), 2019, 98(34): e16862. doi: 10.1097/MD.0000000000016862.
18. Wei YS, Liu WL, Bai R, et al. The use of a transolecranon pin joystick technique in the treatment of multidirectionally unstable supracondylar humeral fractures in children. J Pediatr Orthop B, 2020, 29(5): 452-457.
19. Wang SB, Lin BH, Liu W, et al. Modified closed reduction and percutaneous Kirschner wires internal fixation for treatment of supracondylar humerus fractures in children. Curr Med Sci, 2021, 41(4): 777-781.
20. Yousri T, Tarassoli P, Whitehouse M, et al. Systematic review of randomized controlled trials comparing efficacy of crossed versus lateral K-wire fixation in extension type Gartland type Ⅲ supracondylar fractures of the humerus in children. Ortop Traumatol Rehabil, 2012, 14(5): 397-405.
21. Li J, Rai S, Tang X, et al. Surgical management of delayed Gartland type Ⅲsupracondylar humeral fractures in children: A retrospective comparison of radial external fixator and crossed pinning. Medicine (Baltimore), 2020, 99(10): e19449. doi: 10.1097/MD.0000000000019449.
22. 黃晉, 羅鵬飛, 劉春娥. 手法閉合復位配合兩種克氏針固定方式治療GartlandⅡ型和Ⅲ型兒童肱骨髁上骨折療效比較. 中國骨傷, 2020, 33(10): 895-902.
23. Li M, Xu J, Hu T, et al. Surgical management of Gartland type Ⅲ supracondylar humerus fractures in older children: a retrospective study. J Pediatr Orthop B, 2019, 28(6): 530-535.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of double joystick technique assisted treatment of Gartland type Ⅲ supracondylar fractures of the humerus in children

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