Objective To investigate the effectiveness of joystick technique assisted closed reduction and cannulated screw fixation in the treatment of femoral neck fracture. Methods Seventy-four patients with fresh femoral neck fractures who met the selection criteria between April 2017 and December 2018 were selected and divided into observation group (36 cases with closed reduction assisted by joystick technique) and control group (38 cases with closed manual reduction). There was no significant difference in gender, age, fracture side, cause of injury, Garden classification, Pauwels classification, time from injury to operation, and complications (except for hypertension) between the two groups (P>0.05). The operation time, intraoperative infusion volume, complications, and femoral neck shortening were recorded and compared between the two groups. Garden reduction index was used to evaluate the effect of fracture reduction, and score of fracture reduction (SFR) was designed and was used to evaluate the subtle reduction effect of joystick technique. ResultsThe operation was successfully completed in both groups. There was no significant difference in operation time and intraoperative infusion volume between the two groups (P>0.05). All patients were followed up 17-38 months, with an average of 27.7 months. Two patients in the observation group received joint replacement due to failure of internal fixation during the follow-up, and the other patients had fracture healing. Within 1 week after operation, the Garden reduxtion index of the observation group was better than the control group; the SFR score of the observation group was also higher than that of the control group; the proportion of femoral neck shortening within 1 week after operation and at 1 year after operation in the observation group were lower than those in the control group. The differences of the above indexes between the two groups were significant (P<0.05). ConclusionThe joystick technique can improve the effectiveness of closed reduction of femoral neck fractures and reduce the incidence of femoral neck shortening. The designed SFR score can directly and objectively evaluate the reduction effect of femoral neck fracture.
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.
ObjectiveTo evaluate the effectiveness and safety of Ilizarov technique combined with the “joystick technique” for the treatment of fourth brachymetatarsia. Methods A retrospective analysis was performed on 53 patients with fourth brachymetatarsia who met the selection criteria and were treated between August 2021 and January 2025. Patients were divided into two groups according to the surgical method: group A (Ilizarov combined with “joystick technique”, n=19) and group B (Ilizarov alone, n=34). There was no significant difference in baseline data between the two groups (P>0.05), including gender, age, side, preoperative fourth metatarsal length, preoperative shortening of the fourth metatarsal, and American Orthopaedic Foot and Ankle Society (AOFAS) score. The operation time, intraoperative fluoroscopy frequency, total hospitalization costs, and complications were recorded and compared between groups. Metatarsal length was measured preoperatively and at 3 months postoperatively to calculate the lengthening amount. Foot function was evaluated using the AOFAS score preoperatively and at 4 months postoperatively. Patient satisfaction was assessed using a self-designed scale at 4 months postoperatively. Results All surgeries were successfully completed. The operation time and intraoperative fluoroscopy frequency were significantly lower in group A than in group B (P<0.05), while total hospitalization costs showed no significant difference (P>0.05). All patients were followed up, with a follow-up of (6.26±1.52) months in group A and (6.70±1.55) months in group B (t=?0.978, P=0.333). At 3 months postoperatively, the metatarsal lengthening was comparable between the two groups, with no significant difference (P>0.05). At 4 months postoperatively, AOFAS scores improved in both groups when compared with preoperative values, and the change in AOFAS score was greater in group A than in group B, the differences were significant (P<0.05). There were 2 cases of metatarsophalangeal joint stiffness and 1 case of metatarsophalangeal joint dislocation in group A, and 2 cases of nonunion, 2 cases of metatarsophalangeal joint dislocation, 3 cases of metatarsophalangeal joint dislocation with metatarsophalangeal joint stiffness, and 8 cases of simple metatarsophalangeal joint stiffness in group B. No pin-tract infection occurred in either group. The overall incidences of complications were 15.8% in group A and 44.1% in group B, with a significant difference (P<0.05). At 4 months postoperatively, patient satisfaction in group A was significantly better than that in group B (P<0.05). ConclusionThe Ilizarov technique combined with the “joystick technique” can significantly optimize surgical efficiency, reduce intraoperative trauma and the risk of complications, and promote better functional recovery and patient satisfaction. It represents a favorable option for the treatment of fourth brachymetatarsia.
