Effectiveness of double joystick technique assisted treatment of Gartland type <b>Ⅲ</b> supracondylar humeral fractures 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 humeral fracture; closed reduction; children

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 humeral fracture (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 accidental falls and were classified as extension-type. X-ray film showed that 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 and carrying angle of bilateral elbows were measured. Elbow joint function was evaluated using the range of motion (flexion and extension) and the Flynn criteria. 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 was (73.50±3.46)°, and the carrying angle and the range of motion in flexion and extension of the affected elbow 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 facilitates the closed reduction and Kirschner wire internal fixation of Gartland type Ⅲ SCFH in children without increasing risk of complications.

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.	韦宜山, 刘万林, 崔鹏飞, 等. 尺骨鹰嘴穿针操纵杆技术辅助治疗儿童多方向不稳定肱骨髁上骨折的对比研究. 中华小儿外科杂志, 2020, 41(6): 542-549.
6.	马海龙, 刘方, 周志林, 等. 克氏针重建内, 外侧柱骨膜铰链辅助儿童多方向不稳定肱骨髁上骨折闭合复位的疗效研究. 中国修复重建外科杂志, 2023, 37(10): 1220-1224.
7.	刘旭, 吴伟, 单宇宙, 等. 极度屈肘位下肘横纹延长线在儿童伸直型肱骨髁上骨折尺侧置针定位中的应用. 中国修复重建外科杂志, 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.	文玉伟, 王强, 宋宝健, 等. 闭合复位与桡侧交叉克氏针治疗儿童Gartland Ⅲ型肱骨髁上骨折. 中华小儿外科杂志, 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.	潘天龙, 侯相华, 张敬东. 手术时机对闭合复位经皮克氏针内固定术治疗儿童肱骨髁上骨折疗效影响的研究. 中国修复重建外科杂志, 2025, 39(5): 569-573.
15.	褚祥军, 孙军, 刘永, 等. 儿童肱骨髁上骨折闭合复位失败的处理与因素. 中国矫形外科杂志, 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.	黄晋, 罗鹏飞, 刘春娥. 手法闭合复位配合两种克氏针固定方式治疗GartlandⅡ型和Ⅲ型儿童肱骨髁上骨折疗效比较. 中国骨伤, 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. 韦宜山, 刘万林, 崔鹏飞, 等. 尺骨鹰嘴穿针操纵杆技术辅助治疗儿童多方向不稳定肱骨髁上骨折的对比研究. 中华小儿外科杂志, 2020, 41(6): 542-549.
6. 马海龙, 刘方, 周志林, 等. 克氏针重建内, 外侧柱骨膜铰链辅助儿童多方向不稳定肱骨髁上骨折闭合复位的疗效研究. 中国修复重建外科杂志, 2023, 37(10): 1220-1224.
7. 刘旭, 吴伟, 单宇宙, 等. 极度屈肘位下肘横纹延长线在儿童伸直型肱骨髁上骨折尺侧置针定位中的应用. 中国修复重建外科杂志, 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. 文玉伟, 王强, 宋宝健, 等. 闭合复位与桡侧交叉克氏针治疗儿童Gartland Ⅲ型肱骨髁上骨折. 中华小儿外科杂志, 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. 潘天龙, 侯相华, 张敬东. 手术时机对闭合复位经皮克氏针内固定术治疗儿童肱骨髁上骨折疗效影响的研究. 中国修复重建外科杂志, 2025, 39(5): 569-573.
15. 褚祥军, 孙军, 刘永, 等. 儿童肱骨髁上骨折闭合复位失败的处理与因素. 中国矫形外科杂志, 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. 黄晋, 罗鹏飞, 刘春娥. 手法闭合复位配合两种克氏针固定方式治疗GartlandⅡ型和Ⅲ型儿童肱骨髁上骨折疗效比较. 中国骨伤, 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.

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