title: The use of a joystick technique facilitates closed reduction and percutaneous fixation of multidirectionally unstable supracondylar humeral fractures in children.
abstract: BACKGROUND
  Multidirectionally unstable supracondylar fracture of the distal humerus presents with severe instability in both flexion and extension. Closed reduction and percutaneous fixation is challenging and may not be obtained by the traditional reduction maneuver.
  
  
  METHODS
  We retrospectively evaluated 8 children (4 boys and 4 girls) with a mean age at presentation of 7.6 years (range, 5.3 to 10.9 y) who underwent closed reduction and percutaneous fixation using a joystick technique for the treatment of multidirectionally unstable supracondylar fractures. Clinical and functional results were assessed by the system described by Flynn. Radiographs at last follow-up were compared with those taken immediate after pinning as well as with normal contralateral elbow radiographs at final follow-up.
  
  
  RESULTS
  After an average follow-up of 14.5 months (range, 12 to 24 mo), there was no difference between the injured upper extremity and the contralateral side according to cosmetic, functional, and radiographic evaluation. There was no complication such as pin-site infection, loss of fixation, malunion, cubitus varus, iatrogenic nerve injury, or need for further surgery.
  
  
  CONCLUSIONS
  The joystick technique is a safe and effective method that can avoid aggressive and frustrating attempts of closed reduction and further open reduction of multidirectionally unstable supracondylar fractures of the humerus in children.
  
  
  METHODS
  Level IV-case series.
authors.affiliation: Department of Orthopedic Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO 80045, USA. eduardo.novais@childrenscolorado.org
authors.forename: Eduardo N
authors.initials: EN
authors.lastname: Novais
authors.forename: Marco A P
authors.initials: MA
authors.lastname: Andrade
authors.forename: Davi C
authors.initials: DC
authors.lastname: Gomes
mesh_terms: D002648:Child; D002675:Child, Preschool; D004551:Elbow Joint; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies