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A comparative study of two closed reduction methods for pediatric supracondylar humeral fractures
Yue-Li Zhu1, Wei Hu1, Xian-Bin Yu1
1Department of Orthopaedic Surgery, Second Affiliated Hospital & Yuying Children' Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
Insights
The joystick technique offers a higher success rate for closed reduction of pediatric supracondylar humeral fractures compared to traditional manual traction. This method reduces operative and fluoroscopy times, improving outcomes for pediatric fracture treatment.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Trauma Surgery
Background:
- Limited evidence exists comparing joystick technique with traditional manual traction for pediatric supracondylar humeral fractures.
- The study aimed to evaluate the efficacy of the joystick technique versus traditional manual traction in closed reduction.
Purpose of the Study:
- To compare the success rates and clinical outcomes of joystick technique and traditional manual traction for closed reduction of pediatric supracondylar humeral fractures.
Main Methods:
- A prospective study included 68 pediatric patients with supracondylar humeral fractures, divided into two groups (34 each).
- Group A utilized the joystick technique, while Group B used traditional manual traction.
- Outcomes assessed included operative time, fluoroscopy time, union time, complications, and functional results using the Flynn scoring system.
Main Results:
- The joystick technique achieved a 100% success rate in closed reduction, significantly higher than the 73.5% success rate with traditional manual traction (P=0.004).
- Operative time and fluoroscopy time were significantly shorter with the joystick technique.
- No significant differences were observed in hospitalization time, bone union, complication rates, or functional outcomes.
Conclusions:
- The joystick technique is a more effective method for closed reduction of pediatric supracondylar humeral fractures, especially when traditional methods fail.
- It offers advantages in terms of success rate and reduced operative/fluoroscopy times.
Background:
No randomized controlled studies have confirmed the advantages of the joystick technique over the traditional manual traction. The objective of this study was to compare the results of the joystick technique and the traditional manual traction for facilitating closed reduction of pediatric supracondylar humeral fractures.
Methods:
From February 2009 to December 2012, sixty eight children were included in this study. Group A included 34 fractures reduced by the joystick technique. Group B consisted of 34 fractures reduced by the traditional manual traction. Preoperative demographic data were comparable between the two groups. The operative time, fluoroscopy time, hospitalization time, time to bone union, complications were recorded in both groups. Radiologic and functional results were assessed using the Flynn scoring system.
Results:
Closed reduction was successfully done in all the fractures of Group A while traditional closed manipulation was successfully done in 25 fractures of Group B and 9 fractures failed. There was a significant difference between the two groups in the rate of failed closed reduction (P = 0.004). The mean operative time was 30.5 ± 9.0 and 48.2 ± 16.4 min, and the mean fluoroscopy time was 25.4 ± 10.5 s and 55.0 ± 21.2 s in Group A and Group B, respectively. Both the operative time and fluoroscopy time were significantly longer in Group B (P < 0.001 and 0.001, respectively). However, there was no significant difference in terms of the mean hospitalization time, mean union time, total complications, the Flynn scores between the two groups (P > 0.05).
Conclusions:
The joystick technique should be chosen to facilitate closed reduction if traditional manual traction failed to yield an acceptable reduction.
