title: A new joystick technique for unsuccessful closed reduction of supracondylar humeral fractures: minimum trauma.
abstract: BACKGROUND
  The purpose of this study was to compare operation duration, radiological and functional results of the open reduction with either posterior or lateral approach and closed reduction with joystick method in unsuccessful closed reduction of displaced (Gartland type III) supracondylar humeral fractures.
  
  
  METHODS
  Between February 2010 and August 2011, 37 patients who were not obtained satisfactory reduction with classic closed reduction attempts for three times in operating room were included in this study. Patients were treated with three different surgical methods. Group I have 13 patients who had joystick and lateral K-wire-assisted closed reduction, group II have 12 patients who had open reduction by lateral approach, and group III have 12 patients who had open reduction by posterior approach. In final follow-up, AP and lateral radiographs of both elbows were taken and bilateral Baumann angles, lateral humerocapitellar angles, carrying angles, and elbow range of motion were measured. These angles and operation times compared between the groups. The functional and cosmetic outcome of surgery was evaluated by criteria of Flynn et al.
  
  
  RESULTS
  There was no statistical significance difference between Baumann angles, lateral humerocapitellar angles, and carrying angles of fractured and uninjured sides in between three groups (respectively, p = 0.761, p = 0.354, p = 0.750). In group I, operation duration is shorter than the other groups. Functional scoring showed that in group I and group II, all patients have satisfactory results; however, in group III, three patients (25%) had poor results. In the perspective of cosmetic results, all three groups have satisfactory results.
  
  
  CONCLUSIONS
  When classical closed reduction fail, lateral joystick and K-wire-assisted reduction is a useful way to make and maintain the reduction. Functional and radiological results are as good as lateral and posterior open approaches. Short operation time is an advantage. This method reduces the risk of complications due to repeated closed reduction and open reduction in unsuccessful closed reduction in pediatric supracondylar humeral fractures.
  
  
  METHODS
  Level III.
authors.affiliation: Department of Orthopaedic and Traumatology, Faculty of Medicine, Karabuk University, Karabuk, Turkey, drserdarhakan@gmail.com.
authors.forename: Serdar Hakan
authors.initials: SH
authors.lastname: Basaran
authors.forename: Ersin
authors.initials: E
authors.lastname: Ercin
authors.forename: Mustafa Gokhan
authors.initials: MG
authors.lastname: Bilgili
authors.forename: Alkan
authors.initials: A
authors.lastname: Bayrak
authors.forename: Huseyin
authors.initials: H
authors.lastname: Cumen
authors.forename: Mustafa Cevdet
authors.initials: MC
authors.lastname: Avkan
mesh_terms: D001864:Bone Wires; D002648:Child; D002675:Child, Preschool; D004551:Elbow Joint / Q000503:physiopathology; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D061646:Operative Time; D011859:Radiography; D016059:Range of Motion, Articular; D019233:Retreatment; D012189:Retrospective Studies; D015599:Trauma Severity Indices; D017211:Treatment Failure; D000092464:Elbow Injuries